Organised by: Maria Faktorova, co-ordinator of OT Programme, Charles University, Prague
Coordinated by: Hanneke van Bruggen, executive director ENOTHE
Minutes by: Linda Renton, honorary secretary of ENOTHE
Granted by: European Commission, ERASMUS, Thematic Network Projects
Opening of the Meeting-
Nils Erik Ness, President of ENOTHE
Representatives from the Ministry, persons with disability, guests, Czech colleagues and hosts, dear collaborating ENOTHE members: during this 10th year of ENOTHE our activities and developments are increasing, let me say exploding in different areas. It is within four areas, in line with the Bologna declaration, that ENOTHE is focusing its work: first within Harmonisation and Quality where we are developing and trying out a tool for international peer evaluation of Occupational Therapy programmes. The Peer review guidelines will be developed to be a tool for quality assurance of Occupational Therapy education. Saying Harmonisation we are also looking at the concepts used within Occupational Therapy where our Terminology group are doing advanced work in interpreting and defining concepts in different languages. Another area within Harmonisation and Quality is development of interaction between East - Central and West Europe, as also this meeting shows if we are looking at the countries that are represented here today. Intense work is being done in developing Occupational Therapy education in Georgia and Romania, also including neighbouring countries. Tomorrow morning we will hear more about European politics within this area of Quality development by TUNING advisor Dr Katherine Isaacs.
The second area of ENOTHE activities is European Dimension, where a working group are developing and running an internet course for students called "Occupational Therapy in Europe"; fourteen universities have shown interest in this projects run by the European Dimension group. The third area is Continuing Education and Research where we have chosen to put a priority on Occupational Science; developing a self study package on internet. The Occupational Science group is also discussing development of a master's level module within Occupational Science. Occupational Science has been a priority when inviting key speakers to our ENOTHE-meetings. This year we are very happy to have Dr Elisabeth Townsend here to lecture on the concept of Occupational Justice. This is a timely subject for elaboration, especially during this European year of the disabled. As all development in Occupational Therapy should start with the people we are serving we will today also have key speakers representing this: Dr Monika Madai from the Hungarian Council of Disability and the president of Czech National Disability Council, Vaclav Krasa. As the fourth area of activities we have Teaching Methods with two working groups focusing on teaching Practical Skills in Occupational Therapy and Problem Based Learning. Publications and Website are being developed. We are happy to have one of Europe's experts in PBL here tomorrow as key speaker, Dr Henk Schmidt.
ENOTHE is growing and we now have 156 full or contributing members, and have never had so many members at our yearly meetings. Note that this year we also have members and interested participants from as far away as Egypt, Palestine and Uzbekistan. I especially call on the OT programmes in North and West Europe to seek collaboration with partners in East and South, since this challenge of cultural interaction is a source for new development and new ways of looking at our profession.
During this meeting we have invited Kit Sinclair (president of the World Federation of Occupational Therapists) and principal lecturer Clare Hocking (leader of the revision of WFOT Minimum Standards), to do an external evaluation of ENOTHE. Some of you will be approached for questions or focus groups. The board welcomes this evaluation very much and encourages the participants to feel free to give their opinion on ENOTHE.
I will already from the beginning of this meeting extend a warm thank you to our hosts at Charles University who have been planning this meeting - it is not easy since our network and activities have been growing intensely since they first accepted this heavy burden. Practical arrangement of this conference leans heavily on the local hosts, lead by Maria Krivosikova, her colleagues and students. On behalf of the board I warmly welcome you to the ENOTHE's ninth annual meeting. Be challenged by new ways of doing our work, find new partners and make a better contemporary education with the aim to enable occupation for all people.
Welcome -
Dr. MuDr. Ottomar Kittnan Csc., Vice Dean First Faculty of Medicine, Charles University, Prague, Czech Republic
Dr. Kittnan said it was an honour to welcome all participants to Prague and the Charles University. He explained how Charles University is one of the oldest universities in the world and that it was established in 1748. In the First Faculty there are a 1000 teaching staff and it is one of the oldest and biggest in the University. Although it is old, well established and traditional it was the first establishment to offer an occupational therapy programme. Occupational therapy at Charles University is now internationally accepted and qualified occupational therapists are needed in the Czech Republic. Teaching is offered by specialists in rehabilitation. Hanneke van Bruggen supported the establishment and development of this programme in occupational therapy. The occupational therapy department here in the Charles University has participated with other occupational therapy programmes including: Lund (Sweden), Amsterdam (The Netherlands) and Glasgow (UK) and this has fed into the revision of the occupational therapy programme at the Charles University. The first graduates immediately went on to become teachers, practitioners and also members of Enothe. He once again stated how pleased he was to welcome the Enothe Meeting to Prague and he offered his thanks to the members of the First Faculty for their involvement and also he wished the Ninth Annual Enothe Meeting success.
Welcome -
Kit Sinclair, President World Federation of Occupational Therapists (WFOT)
Kit Sinclair stated how wonderful it was to be here in Prague at the Enothe Annual Meeting. She went on to highlight some issues in relation to the World Federation of Occupational Therapists. She stated how WFOT leads the trends by incorporating the rich diversity in occupational therapy and that it impacts OT at all levels. WFOT links 57 countries and its mission is to increase the practice of OT worldwide. It maintains the minimum standards of practice and WFOT documents and the Website are translated into four languages. WFOT has a glossary of terms and soon all WFOT Bulletins will be on CD ROM (47 issue). WFOT has international links to the World Health Organisation and undertakes joint initiatives with them. It also carries out international consultancy on participation and equalisation. It is developing a position paper on Community Based Rehabilitation. The WFOT World Conference in 2002 was held in Stockholm, Sweden. In 2006 it will be in Asia. In 2002 the WFOT Minimum Standards were revisited and Nils Erik Ness (Norway) and Claire Hocking (New Zealand) worked on them and were the authors. These standards are not specific but focus on the "Person-environment-occupation" interaction and also consider knowledge, attitudes, skills and attributes of the occupational therapist. A new package and CD ROM have been developed. Kit Sinclair then went on to thank the Enothe Board for inviting her and Claire Hocking to this Annual Enothe Meeting, in order to carry out an evaluation of the organisation and functions of Enothe. She invited participants to approach her and share views on Enothe. (Read the full text..»)
Developments of Occupational Therapy within the Czech Health Care System-
Mrs. Proskova, Ministry of Health, Czech Republic
Mrs. Proskova thanked Enothe for inviting her to the meeting. She spoke of occupational therapists now being educated at higher education level and that in the Czech Republic there is now a positive view of health practice. There is still no mention of occupational therapists as Health Care Workers but the Ministry of Education has been trying to promote new legislation for the introduction of occupational therapy and other similar health care services. In the first week of November 2003, the proposed legislation will be presented to the relevant committee of Parliament. It outlines the duties and the moral integrity required of health care workers. Occupational therapy is now a Bachelors degree. Registration of health care workers will be compulsory and there will be a method of each worker proving their ability to meet their duties, every six years.
Developments of Occupational Therapy Education in the Czech Republic-
Maria Faktorova, Programme Coordinator for Occupational Therapy, First Faculty of Medicine, Charles University, Prague, Czech Republic
Maria Faktorova outlined the recent developments in the Czech Republic in relation to occupational therapy education.
(Read the full text..»)
(Overhead 1..») (Powerpoint)
Introduction to Enothe and the Enothe Board Members-
Hanneke van Bruggen, Executive Director Enothe
Hanneke van Bruggen welcomed all participants and guests to the Ninth Annual Meeting of Enothe. This is her 25th visit to Prague. She outlined Enothe. It began in Alborg, Denmark and was initially established for European member countries. There is now a debate as to what constitutes Europe so we are now following the European Community who say that education and educational standards should be shared and spread across Europe which includes the European Union, Associate and New Entry countries, former Russia, the Balkans and the Mediterranean countries. There are now over 140 Enothe members from over 35 countries. Enothe also has some contributing members. She introduced all members of the Board.
A network requires active participation and Enothe needs all participants and members to join in. Hanneke stated that it is the responsibility of members and participants at this conference to participate in the work of Enothe. Occupational therapy is now aimed at the level of higher education; this means at least the level of a Bachelors degree. The general aim of Enothe is to advance knowledge of occupational therapy to professionals, users and employers. Enothe is linked to European Declarations i.e. Bologna, Prague and Berlin. Tuning and Quality Assurance are contemporary issues in occupational therapy as well as those of Continuing Education, Research and Innovative Teaching Methods. Hanneke van Bruggen outlined the outcomes and products which will be available in Athens 2004. She also suggested the following spin offs from Enothe as being: keeping up to date on EU courses; sharing good practice; equality for people with disabilities; professional recognition and synergy between international projects. She then welcomed Kit Sinclair and Claire Hocking to the meeting and explained briefly the reason why the Enothe Board invited them to evaluate Enothe.
(Overhead 2..») (Powerpoint)
Occupational Justice; everyday ethical, moral and civic issues for an inclusive world-
Dr. Elizabeth Townsend, Professor and Director of the School of Occupational Therapy, Dalhousie University, Canada
Occupational justice is based in hope. The purpose of this presentation is to consider what ethical, moral and civic morals command attention to occupational justice. Also what paradigm of justice distinguishes occupational justice. A video was then shown of a mental health day programme community setting. The people in the video were not living in jail, literally, but they were metaphorically locked behind bars. They are excluded from employment and are also stigmatised and marginalised due to their mental health. Could our world be radically different? Most people are for justice, but then to be concerned with the protection of ourselves (habits, routines, privileges). Could we hope for the ethical, moral and civic principals of occupational justice? The three concerns of this are: what concerns us (participation in daily life), how we work (through enabling approaches with client centred approaches leading to empowerment) and why do OTs do this (to enable occupation). Ann Wilcock and Liz Townsend defend occupational justice. OTs concern is about helping people with daily life or occupations, but not all occupations are a positive experience. Occupations can be a foundation for everyday life i.e. trauma, identity, belonging, choice, personal and social balance, enrichment, social integration, social inclusion and equity.
How Do We Work Through Occupation? We engage people in occupations and look at what the engagement means. Enabling means being client centred, working without arrogance, listening to and respecting difference, drawing on the potential of others and establishing structures and rulings for equitable inclusion.
Justice. This is about how we draw people into participating in daily life. OT attempts to develop understanding of enabling. Why are we concerned about occupation? Often environments exclude people from involvement in occupation. Occupational injustices occur when participation in daily life occupations are barred, trapped, confined, segregated, restricted, prohibited, undeveloped, disrupted, alienated, imbalanced, deprived, marginalised. For example one can be trapped in a narrow life in old age, confined due to poverty, segregated by incarceration, deprived due to war. Society tolerates an occupational apartheid, in which we recognise at least two societies where some have occupationally just lives and others do not.
What paradigms of justice illuminate social justice from occupational justice? This can be highlighted by having two headings: "having" (distribution, possession, things, hierarchy, social) and "doing" (opportunity, enablement, power and privilege, participatory and occupational). Townsend suggested a charter of occupational rights.
The right to increase human potential through participation in occupations (injustices=occupational depravations). The right to safety and to participate in occupations (injustices=occupational intimidation, confinement). Right to choice and to decide how participation in occupations impacts on experiences of meaning, health and inclusion (injustices= occupational marginalisation and alienation). The right to fair privileges and pay for different participation in occupations (injustices=occupational imbalance). Liz Townsend then outlined the proposed work, which was going to take place later in the meeting, which would explore more about ethical and moral issues. She also suggested the processes of practice would be considered in the workshops. In closing she asked the participants to consider a radically different world where occupational justice would exist.
(Read the full text..») (Word 59KB)
Opportunities for Disabled People and their NGOs in facing the entry of Hungary into the European Union-
Dr. Mónika Mádai, Hungarian National Council on Disability
Dr. Mónika Mádai explained that she has been disabled since birth. She feels she can speak for a wide diversity of disabled people and she explained that in Hungary five years ago the Council of Disability was founded. This was established at Ministry level and was made up of representatives from the Government Ministries and disabled people. Mónika was very proud to be elected from 1000 Non Government Organisations (NGOs) of disabled people. In Hungary, since 1980 the Government has run four NGOs of disabled people, they have learned to express themselves well now and they have created an organisation called Send Workshop. The purpose of this is to tell honestly the situation of disabled people regarding laws, justice and prohibition. It has three tasks: to control prohibition, to monitor the situation of disabled people and to advise the Government. Hungary will accede into the EU. NGOs in Hungary are important as they have a role in using money for social integration.
Occupational Therapy is a new discipline in Hungary. Dr. Mádai spoke about accessibility being more than just ramps and wide doors. It is also about participation in the world. Disabled people need help, but they are not "lower" than others, or live in a different world; perhaps occupational therapy is a new methodology to help with integration.
There is a new Ministry in Hungary and the minister of this department is a woman and she is responsible for Equal Opportunities (gender, disability etc.). The Hungarian NGOs are keen to liaise and help her create a more equal and just system for daily life.
The European Disability Forum organised a meeting, in Brussels, one year ago for the European Year of Disabled People. It looked at plans and events for the year and many European NGOs attended. Also in April this year, in Athens, the European Disability Forum and the European Youth Forum (non-disabled) organised a meeting together. The youth of Europe met together to promote real social integration. These two huge organisations came together on the topic of disability.
Dr. Mádai stated that she was very happy to be here in Prague; to her it feels like a step forward with regard to networking and sharing knowledge and skills. She then went on to tell a little of her personal story. Her personal assistant, who accompanied her to this meeting, is hard of hearing and it is her first time at a conference. If one is disabled one should not be segregated and we need to train younger people and show them the way. This she applied to her personal assistant and she therefore wanted to introduce her to all of the participants.
Czech Vision on Equality-
Mr. Vaclav Krasa, President Czech National Disability Council
Mr Krasa opened his talk by saying how pleased he was to be at the Enothe Meeting. He introduced himself as being a spokesman for an organisation for people with disabilities. He described the Czech National Disability Council (CNDC) as being a political group for citizens with disabilities to promote the interests and needs of people with disabilities. It is concerned with legislation and promoting equal opportunities. They initiate remedies for shortcomings and they organise conferences to promote equal opportunities. He went on to say that disabled people do not need charity, just equality, funding and human rights. Children with physical disabilities suffer from poor attitudes towards them and they need barrier free schools. It is up to society to decide if these children get educated and if it finds funds for them. Education is a factor for future independence for these children.
Employment in also important and essential if we are to achieve inclusiveness, but unemployment is increasing in the Czech Republic. Post communist countries have this problem with a lack of employment for disabled people. Increasing lifelong learning and inclusion of disabled people are important. Employment of disabled people is one of the preconditions towards social inclusion. The Czech Republic needs to undertake the assessment of this problem of unemployment.
The CNDC is active in all regions and is interested in labour law (employment) and discrimination in relation to people with disabilities. They work with both the government and the NGOs. Mr Krasa felt that some NGOs could have been more active in promoting the voice of disabled people.
The social care service in the Czech Republic can be problematic, as the spectrum of services offered to disabled people is rather basic. In relation to social services, NGOs do offer some care but it can be problematic. The number of beds available per 100,000 is limited. Large institutions are run on a medical rather than social care approach. This segregates rather than includes people with disabilities. Basic human rights are being infringed. The institutions hinder the right of choice and there are no ways of increasing the rights of people with disabilities. Even after ten years there has been little change regarding the development of adequate social services. Clients in the Czech Republic feel that they have some co-operation with occupational therapists and physiotherapists, but greater co-operation is needed.
Mr Krasa thanked the participants for the opportunity to speak as he wanted to make them aware of the range of problems for people with disabilities; however he stated that he does realise that occupational therapists have some level of understanding of the needs of disabled people. The Czech Republic has been quite successful in a number of areas as there is now some representation of disabled people and they feel involved in the political scene. But he stated that he feels that all the relevant organisations need to pull together into a stronger political force to facilitate a fuller integration in Europe. (Read the full text..»)
Occupational Justice; Occupational Processes-
Dr. Elizabeth Townsend
Sarah Kantartis, Vice President of ENOTHE, welcomed Professor Elizabeth Townsend. Professor Townsend showed a number of slides depicting a day centre/ housing support centre for people with mental health problems. She then stated that it is in the barriers to daily life that occupational justice becomes useful. She went on to explore the concept of the process of practice and how can we work towards reducing these barriers. She suggested the following: identify human barriers, negotiate a justice framework, name the occupational justice issues, design programmes, identify the strengths and resources, implement and evaluate services.
Professor Townsend then asked the participants to select a setting and consider the occupational justice issues. Feedback included: asylum seekers, older people (marginalised), children in main stream schools with developmental coordination disorders (excluded from friendships), adults with physical problems (limited access), adults with emotional problems, second generation immigrants, trauma and injury. This discussion highlighted the diversity of the people we work with and the occupational justice issues. Professor Townsend then went on to explore what is it that occupational therapy can bring. She showed a video of staff from the community support centre being interviewed and the clients sharing their poetry and music. What human resources can we bring? The staff and clients have a lot to bring and OT world wide is still very small. She then asked participants to "List the human resources to work on occupational justice" and there was general feedback and discussion. The following resources were identified: politicians and policy makers, clients, media, building authorities, social environment, the family, the government, friends, trade unions, employers, voluntary organisations, specialist engineering skills. Professor Townsend then raised the issue of "specific issues we would wish to work on with these groups" and she suggested that we need a framework for working with these groups and to see beyond the occupational injustices identified within the handout she distributed (issues of being trapped and barred). She emphasised the Charter of Occupational Rights.
She then went on and asked the group to get into pairs or small groups; for one person role play was an interview with one or more occupational justice issues, and negotiating a justice framework with the population and in the setting selected. Then she role played a scenario on the topic of an out of work person. As a profession we need time to get people to talk to us, using innovative practice if necessary. Programme designs should be negotiated, strengths and resources need to be identified and the programmes need to be implemented and evaluated using paradigms of occupational justice to evaluate them. Clients should be included in the evaluation process.
In summary Professor Townsend suggests we look at OT in practical terms and at how we are going to work for clients and bring awareness of occupational justice.
The relationship between memory and instrumental activities of daily living in brain damaged adults-
Maria Faktorova, head OT programme, First Faculty of Medicine, Charles University, Prague, Czech Republic
This thesis aims to examine how specific memory abilities, measured by the RBMT (Rivermead Behavioural Memory Test), are associated with performance on selected instrumental activities of daily living measured by the I ADL Scale (Instrumental ADL Scale) in clients following brain damage. Furthermore, to investigate if the occupational performance can be predicted from memory deficits measured by RBMT.
Ninety-six adult participants with brain damage were assessed by the RBMT and I ADL Scale over a seven-month period. The descriptive statistics, Spearman´s rho correlation coefficient and linear regression equation was used in this correlational study. RBMT demonstrated in this study statistically significant associations with occupational performance measured by I ADL Scale both for male and female scores (rho=.71; p 0,001; rho=.65; p 0,001). The strongest association was found in item ability to handle the finance and transportation. In a series of linear regression models, memory functioning was a predictor for observed and reported I ADLs tasks. This study confirms that memory functions had a significant impact on I ADL ability in this population. Further, it supports the RBMT predictive ability and criterion-referenced validity to identify problems in Instrumental ADLs. From the wide point of view this knowledge could help to identify the clients, who most likely will experience problems in everyday memory tasks and thus this identification will streamline occupational therapy assessment and treatment process.
Daily occupations with or without pain - an explorative qualitative study-
Ton Satink, Lecturer, Hogeschool van Amsterdam, the Netherlands
Low back pain is in Western countries one of the main healthcare problems. Occupational therapists meet many patients with chronic low back pain in order to try to coach and enable them to perform in engaging occupations. The experiences and background of people suffering low back pain provides a rich source of knowledge occupational therapists can use. The presentation will discuss the results of a qualitative study under Dutch clients with chronic low back pain. The explorative study is looking at how chronic low back pain influences the motives for occupational performance. A narrative approach has been used throughout the study and the data is analysed with the constant comparative method with a focus on narrative analysis. Three phases in the process of living with low back pain were identified in which 'the self, 'the pain' and 'the environment' were seen as interrelated elements that influence the motives for occupational performance. In the first phase, clients wanted to meet social and personal expectations, which led them to ignore the low back pain. Subsequently, the pain took control and the clients withdrew from social participation, which led to 'emotional pain'. In the third phase, the participants became more conscious of the interrelating elements and dilemmas: 'Engaging occupations and social participation with or without pain'. How occupational therapists can learn from clients' narratives about their experiences in their processes of dealing with chronic pain will be discussed.
The experiences of being employed from the perspective of participants in a vocational training programme -
Gitte Mathiasson, School of Occupational Therapy, Holstebro, Denmark
The aim of this qualitative study was to reveal how participants in a vocational training programme experienced being employed, as a part of their vocational training. Six participants were interviewed and data were analysed using a modified form of the EPP (empirical phenomenological psychological)-method. Findings revealed how the participants past experiences as unemployed influenced the present experiences of being employed, which again were affected by expectations and concerns for the future. Unemployment in contrary to employment was described as living two different lives, emphasising the importance of performing goal-oriented and meaningful occupations as employed. Findings revealed coherence between the performance of meaningful occupations in a supportive environment and the development of occupational identity and an emerging feeling of well being. Employment was experienced as essential towards societal participation and inclusion. The feeling of having a fluctuating relationship to the labour market was apparent and affected future expectations. Findings were discussed and implications for future development of vocational training programmes were considered.
Clinical reasoning in the process of providing assistive devices;
A clinical reasoning study of how Danish occupational therapists and their clients reason in the process of providing assistive devices in order to enable occupation-
Bente Hartvig, international co-ordinator, Ergoterapeutskolen, Aalborg, Denmark
This qualitative study is a clinical reasoning study with an ethnographic approach aiming at an understanding of how Danish occupational therapists and their clients reason in the process of providing assistive devices.
Data were collected among four Danish occupational therapists and their clients during several visits in four municipalities over a period of four months. Data collection included strategies such as participant observations, video recording reflected on by the occupational therapists, an open ended interview with the clients and the occupational therapists.
Constant comparative method was used to analyse the field notes and the transcribed interview text.
Two main categories and nine sub categories emerged from the analysis.
The results demonstrated that occupational therapists and their clients were thinking in facilitating a partnership in adapting occupations over time and were trying to come up with solutions in the perspective of the occupational therapist and the perspective of the client.
The occupational therapists were thinking in making and realising adaptive strategies focusing on occupational habits, occupational balance and risk factors. The clients were thinking of finding a daily rhythm in their everyday doings being a user of an assistive device. Accordingly, the occupational therapists were engaged in facilitating the acceptance of the life-situation. They had a focus on human temporality towards the client, the occupation and the process. Further, the occupational therapists had to balance between making clinical judgement as well as legal judgement whereas the clients had to adjust and accept the decisions made according to the institutional frames.
The different aspects of the occupational thinking and the dilemma of having to make different judgement at the same time require further study.
The Main Condition for Integration of People with Disabilities is free mobility, mobility for all-
Dr. Tatiana Sindelar, Chairperson MOBILIS, Czech Republic.
Motto:
To achieve progress, we must base our activities on success. Pursuing our own interest must in no way endanger or limit 90 or more percent of the population, but in the end, must be beneficial for them.
Several basic ideas from the Czech National Development Program Mobility for All (hereafter NDPM) will be introduced; it's firstly methodical guideline and several successful results from investment projects.
Future for Children Who Leave School-
Melichar Zdenek, Special School, Pardubice, Czech Republic
The main topics for a discussion were:
The workshop participants had a lively discussion about:
The Use of the Mayers' Lifestyle Questionnaires Within User-Centred Practice-
Dr Chris Mayers, Head of School of Professional Health Studies, York St. John College, UK
Dr Chris Mayers introduced herself and outlined the development, history and aims of the Life Styles Questionnaires 1 and 2 (LSQ). She explained that they use person centred ideas. She outlined the research process they had undergone and the eight areas in the LSQ1 questionnaire were presented. She gave an example from practice and stated the advantages. The main one being that the client is expected to fill in themselves and to "express how it is for me". She then went on to explain the LSQ2 and outlined the content tables, which included 9 issues. She stated the applicability of the questionnaire in different cultures and its variety of uses. She suggested that OTs use it at the beginning and end of their involvement with clients. This presentation gave an overview of the LSQ1 and LSQ2, stating their content, the advantages and experiences to date. Dr Mayers welcomed discussion and encouraged people to contact her at a later date.
When Young Well Educated Disabled Women Get Unemployed After Some Years-
Klara Jakobsen, Assistant Professor, Department of Occupational Therapy, Sør-Trøndelag College, Trondheim, Norway.
Klara Jakobsen presented her study. She began with stating the importance of research. She outlined the participants in the research and gave a short description of how she went about interviewing them regarding their experiences of unemployment. She highlighted two concepts: social and occupational justice. She started with the concept of health promotion and enabling health and the concept that work is meaningful occupation for the participants in the study. During the presentation Klara read out quotes from the participants which highlighted the importance of work to them. She also highlighted the problems with occupational imbalance. The main problems were stated to be transport problems, accessibility, help from services, time needed for self care. She ended the session with questions about the impact on education. In summary the main points were: exclusion of the participants from work, the equal right to work (justice), the impact for OT education, that a client centred focus is required and how we need to avoid occupational depravation.
Occupational Therapy Without Borders - Occupational Justice Education-
Frank Kronenberg, Spirit of Survivors-Occupational Therapists Without Borders, Spain and Nicholas Pollard, Lecturer, Sheffield Hallam University, UK
The session started with introducing the two speakers (Frank kronenberg and Salvador Simó Algado), but only Frank Kronenberg was present. Nick Pollard was there and spoke instead. They outlined the goals and background of their project, and how they are at present editing a book. Frank explained the dolphin symbol of their "Occupational Therapy Without Borders" and how OT has so much potential to offer. Their mission is to develop and implement OT Practice and education and research on this subject. He also outlined the importance of politics and how OTs should be more politically active. Much of the speakers' views were based on the work of Townsend and Wilcock. He explained the "spirit of survivors" being about the actual people we work for, working in communities and by actually doing the work rather than just talking about it. The "OT without borders" is about going beyond the usual boundaries and holism. Also a project in Tibet was presented, which works with blind children, enabling them to access education. Nick Pollard then spoke about a college for people who have been unable to access education in the past and how it is working towards winder access and giving people a second chance. In summary this session introduced the book Frank Kronenberg is editing, introduced people to the project in Tibet, offered video clips on the projects.
Educational Material for Training Occupational Therapy Skills as Developed in the Netherlands-
Inge Speth, Senior Lecturer, Department of Occupational Therapy, Hogeschool Zuyd, Heerlen, The Netherlands.
This session described the educational material the combined Dutch Occupational Therapy Universities of Professional Education have developed for skills training programmes based on the skills lab method. They identified four domains: evaluation, intervention, consultation and communication. A student handbook, instructors manual, CD ROM and observation scales were developed and published in 2003. (Read the full text..»)
Supervision, Supervisors and Clinical Practice; a student's perspective-
Chris Nixon, University of Wales College of Medicine, Cardiff, UK
Chris Nixon presented his research. He began by stating that supervision can be both detrimental and helpful in the training of occupational therapists. The study used a qualitative approach, focus groups. The findings highlighted the following characteristics of a less effective supervisor: no feedback, unapproachable, overly critical, controlling, lack of skills, an effective supervisor possesses the following characteristics; supportive, immediate feedback, positive educator, approachable, proactive, listener, builds confidence, trusting and allowing independence. Coping strategies employed by students on placement include; "keeping one's head down", wanting to just get through, and not causing problems. He also discovered that some students felt that if the supervisor was less effective then this could be positive in terms of material and experiences for reflection. He recommended further research to include collecting the views of supervisors and organisations and also to investigate the role of supervisors in the supervisor process.
Straight Down to the Action: a descent through the conceptual layers of network theories-
Jon Sórgaard, Senior Lecturer, Department of Occupational Therapy, Sør-Trøndelag College, Trondheim, Norway
Jon Sórgaard outlined his views on social theory and occupational science. He shared his exploration of social theory concepts and suggested that we extend the limits of social theory and develop it for occupational science; focus on activities, acknowledge that the work is not social but sociomaterial or sociotechnical, choose between all "actors" that may perform an activity (humans and non humans), evaluate what exactly the "actor" can do and which activities they can not do, construct a network map around activities and tell social scientists that we need a tool which is designed for the complex work of OTs. (Read the full text..»)
New WFOT Minimum Standards. Nils Erik Ness, Assistant Professor, Department of Occupational Therapy , Sør-Trøndelag College, Trondheim, Norway
In this session Nils Erik Ness presented the revised WFOT Minimum Standards (www.wfot.org) and discussion took place regarding the implementation and understanding of these new standards for Education of Occupational therapists.
Student Sessions: European Year of People with Disabilities.
There were 13 groups of students from different countries that took part in the Student Session - students from Austria, The Netherlands, Greece, Georgia, Romania, Bulgaria, Hungary, Belgium, Switzerland, Norway, Germany, Sweden, Denmark, The Czech Republic, Spain and the UK. The topic of the Student Session was the European Year of Disabled People. All the students were asked to explore the following topics: cultural events according to the Year of people with disability in our country in general; how disabled people work on their own promotion according to the Year of people with disability; changes in legislation / new program of the government; the main problem in our country concerning persons with disabilities; what people with disabilities know about OT. The content of the Student Session was in general to present answers to these questions, to present how the year 2003 was influenced in their countries by the European year of people with disability.
The student session was chaired by Czech students all two days.
Countries presented on 31st October 2003 were: Austria, Netherlands, UK, Scotland, Greece,
Countries presented on 1st November 2003 were: Romania, Bulgaria, Hungary, Belgium, Switzerland, Norway, Lithuania, Denmark, Germany, Sweden, and Czech Republic.
(Overhead 5..») (Word 610KB)
Introduction to the Enothe Project Groups-
Hanneke van Bruggen, Executive Director Enothe
Hanneke van Bruggen outlined the work of the groups to date:
Terminology: to create uniformity in professional and educational terminology. This involves consensus definitions, compilation of relevant terms and selection of 10 terms, construction of a database and a Website.
Peer Review group: they piloted a procedure, have carried out three "visits" or reviews and have shared good practice.
East/Central Europe: this group is about the implementation of OT education in the enlarged Europe. This involved a seminar in Lithuania and two new projects in Armenia and Georgia and Romania, Bulgaria and Hungary.
European Dimension: they have developed an Internet course on the European dimension in occupational therapy.
Continuing Education and Research: this group have designed and produced an Internet study pack on occupational science and co-operation in European research.
Innovative Teaching methods: this group has worked on a book for OT educators on problem based learning and also a book on good practice in Europe for teaching practical skills.
(Overhead 6..») (Powerpoint)
The Tuning Process-
Dr Catherine Isaacs, Tuning Advisor
Catherine Isaacs is involved with the Historian Thematic Network, within Europe and she came to explain the Tuning process and to offer Enothe guidance and advice on the topic of Tuning. The EU has requested that all Thematic Networks create a Tuning Forum. She explained the Tuning logo by explaining that this process is about "tuning" educational processes within Europe. She explained what has happened so far. There have been 7 areas (Business, Geology, history, mathematics, physics, education and chemistry), 101 university departments from 16 European countries involved.
The background of the concept came from the Lissabon Process (employability, mobility and life long learning), and the Bologna - Prague Process (comparability, two cycles of higher education, ECTS, increased mobility, curriculum development, integrated programmes and quality assurance). The general objectives of Tuning are: professional profiles, transparency, Europe wide convergence, building of bridges and to design ways to reach out to other subject areas. The methods of Tuning involve four lines. Line 1 is the framework for employability and generic competencies. Line 2 is the mapping of subject areas and the description of core subject specific competencies. Line 3 is the use of European Credit Transfer System (ECTS) as a credit accumulation system; concerned with workloads and the calculation of ECTS points. Line 4 includes the methods of teaching and learning involving assessment, performance, quality assurance and evaluation.
The second stage of Tuning is now to involve the Nursing and European Studies and Thematic Networks. Katherine suggested that Enothe and Tuning proceed by ensuring all members have information on Tuning (http://europe.eu.int/comm/education/tuning/html or www.let.rug.nl/TuningProject). Then she suggested that Enothe follow the Tuning lines, with help from her. The end product would be a booklet with the Enothe and Tuning logos on it.
Hanneke van Bruggen then went on to thank Katherine Isaacs and outlined how Enothe has embraced the Tuning concept.
(Overhead 7..») (Powerpoint)
Terminology
Introduction to work of the group (all group members participated in this stage, providing information on the various stages of the group). The following areas were presented with discussion as required by the participants. The presentations were based on the information prepared for the Website and are available in full there. All group members and participants were introduced. The plan for the workshop was presented.
Formation of the group: the reasons for the groups' formation were presented and the specific goals of the group. Membership of the working group was outlined together with the working languages of the group. Work to date: choice of English as working language of group; decision on which terms to work on; decision NOT to use specific models or frames of reference; sources of literature used; collection of original definitions; collation of definitions on spreadsheets; identification of key elements within each definition; formation of consensus definitions from these elements (concepts); translation of consensus definitions by group members; validation of translation by group of local experts drawn from National Association; educational institutions and clinical settings; preparation for protocol for including new languages. Consensus definitions were presented.
The workshop participants then split into small groups of two or three persons, each group discussing three consensus definitions. The following comments and feedback were discussed. The term occupation - what about motivation, why is this not included in the definition? Discussion regarding the role of meaning in providing motivation. The difference between the definitions of task and activity is not so clear. Discussion related to the translation of terms and to the methodology of the group (i.e. does not aim to produce new model with conceptual links/agreement between terms). Occupational Performance- is there always a conscious choice? Discussion that there is, yes, because that is what makes it occupation. Occupational Performance - participants suggested that the definition implied that only physical action was involved. Following the presentation of the Website there were many positive comments from the participants with the majority stating that they believed it would be a very useful tool. Participants liked the idea of being able to add their own language to the Website.
Final comments and discussion: There was a proposal from a participant that rather than using the term consensus definitions it would be more appropriate to use another term such as conclusion or conclusive definitions. There was considerable discussion and it would seem important to clarify in the presentation of the methodology on the Website the use of the term consensus, as it suggests that a major consensus took place which is not the case (at least in terms of the number of people involved). There was also further discussion regarding the relationship between terms and whether a relationship between the terms had been constructed. It was explained that there was no attempt to construct a relationship between terms as it is not a theoretical model. The participants thanked the working group for a great job.
Action: the group is to review the comments from the participants regarding the consensus definitions. The description of the methodology used will also be reviewed to ensure clarity, particularly in relation to the final comments and discussion. When the Website is available through a link on the ENOTHE Website (April 2004) all members will be requested to provide further feedback.
(Overhead 8..») (Powerpoint)
Teaching Practical Skills-
Gaynor Sadlo, Head OT Programme, University of Brighton, UK, and Gwilym Roberts, Lecturer, University of Wales College of Medicine, Cardiff, UK
This workshop was presented by Gwilym Roberts and Gaynor Sadlo. Teaching practical skills is a central topic to OT education as the raise of academic level drives the schools to decrease skills. The group has decided to propose a small exhibition to show different practices in Europe. This was not an old fashioned message but a way to say that we have to retain the wealth of cultures in Europe. This work may be a contribution of Europe to the rest of the world. Practical skills may be defined as: generic practical skills that any academic student has to learn, such as: communication skills, research skills, core OT practical skills that can be split in 2 categories: the skills that the student will use as OT such as OT assessments, activity analysis and the skills that the student will use as a therapeutic media such as ADL and arts and crafts.
The participants were asked to reflect on the following question with the TPS group members: If we were to start a new OT course tomorrow, what skills should be included, why, how and where? Five groups worked on this question and interesting reflections emerged; the need of resources drives the school to choose: what is the meaning of the choice? We need research with PhD and students to link theory and practice, though there exists research showing we are creative beings and that OT is effective. We have to show that practical skills are scientific. Five different groups worked separately on this question and let emerge different answers and reflections that we synthesise here. First of all, the kind of activities proposed were 'basic activities' but what are they? We can here mention: playing, for children and adults, including drama and puppets ("playing theatre was a nice experience"), sports and leisure activities: ("in the UK you are not credible otherwise"), physical activities, structured activities, crafts, ADL activities: cooking, wheelchair use, transfers. Some advice was given for the choice of activities such as the flexibility and the link with present day society, giving a status to some activities such as using computers and learning to be creative through a website. The students' choice was also stressed as a central point. Moreover, students have to learn new activities but also do activities they know very well. Schools are influenced by the activities used in practice: ADL etc., but also by the need of using a range of activities in relation with age, gender, culture and also insurance. The schools also have the opportunity to influence practice by developing new ways of thinking about the use of practical skills. The resources available for the school may influence the choice as we need materials to learn activities. The reasons of using activities are linked to the philosophy and context of the school. As OTs, we think that activities are essential. Activities are what separate us from other professionals such as physiotherapists... The place given to practical skills depends on the focus of each school. In university, the focus is put on theory, stressing the need of more research on crafts from students and teachers.
The objectives for these activities are to help the student in his/her own development and to train for practice. It is important for the school to meet the needs of the students in order to develop dexterity, creativity, to become more flexible and learn to solve problems. It is also important for students to learn new activities and reflect on this training. Students need to experiment different ways of learning practical skills. They also appreciate a break from theory. When the student has the choice, it motivates him/her and gives the chance to find meaning in what he/she is doing. He/she then will be able to transfer his/her own experience to the client. Some teachers think that it is important to choose but also to experiment with compelled activities ("I hated weaving, but I learned so much!"). The most important objective is to link theory to practice. The theory is not enough; students have to learn practical skills to integrate the theory. The learning of activities will facilitate the students' contact with patients during placements. Through creative activities, students will permit fundamental expression by using another channel. Learning a variety of different activities will allow a personal choice between OT and the client in order to meet the needs of the patient, but also of the society. Through activities, the student will be aware of the sensorial aspect of the activity and will develop observation skills. Nevertheless, research is necessary about the evidence of using practical skills. We need research in OT to link theory to practice. We must not forget that theory comes from practice. It challenges OT beliefs and must be consistent with the school philosophy. We have to defend creative activities to students: why they are important and how we can use these activities.
Questions are emerging such as: what are creative activities now? "Don't be old fashioned!" what does that mean to people to be creative? Why have we lost woodwork in many places? Some have a good experience in using woodwork in special rooms; others think it takes too much time. Many teachers think we should not lose practical skills.
The way of teaching practical skills was discussed by the participants screening different aspects: the teachers, the level, how to do it and assessment. Although, OT teachers are appreciated as they can link theory to practice, expert teachers may be useful to be at ease with the complexity of some activities (architecture design, creative activities...). Peer teaching is also interesting. The level varies throughout Europe. The advice is "enough to know how to improve outside the school". The school should put the right demand on students in order to help them to be competent with the patient doing the activity. The students should participate in the activity and go through the process in order to transfer afterwards to other activities. The study load may be 20 hours per activity including activity analysis in Italy, to 100 hours for creative activities in Denmark or 600 hours in all in Austria. The importance of learning how and why was stressed: analysing practical skills combining theory, OT concepts and clinical reasoning. Activity theories (Leontjev, Cziksentmihaly) link theory to practice and help activity analysis. In Denmark, there is no special course for skills: it is integrated with theory. The media are presented. In some schools, students make products and do research in the library. It is important for the students to experiment in different ways of practice (individual, group activity) and different ways of teaching (teacher-centred, peer teaching, self-teaching, using instruction). The choice given to the students is consistent with OT philosophy. In the UK, the students find their own projects, skills and activities. The creative aspect should be stressed: for example, students can do different things with the same material or they may try to experiment a "creative use of self" in representing themselves as different things such as an island, a forest, etc. In Sweden, they use creative skills in another way in order to stress the meaning of activity in combination with the theory: the student has to learn to transfer to the client situation. The assessment of learning skills may be difficult. For some activities such as creative activities, course attendance can be criteria. For some activities, it is integrated with theory. Some activities may be assessed by a video show. It seems more important to assess competencies (such as using creative activities) than assess the product. In practice, many OTs don't use crafts anymore, except in psychiatry. Nevertheless, in some countries (Germany, Austria, and Italy) activities are still important in many fields. Some UK schools don't do crafts or creative activities at school. Some of these schools are proud to give away crafts but some teachers think they are losing something. The students become "good thinkers" but they are clumsy when they learn splinting. Some teachers recognise students have to develop technical and creative skills to become OTs but they think that it doesn't have to be done at school. In Denmark, they don't have skill labs anymore. The students do the activities outside but the analysis is done in the school. Many teachers, though, think we should retain activity and skills within curricula. Nevertheless, it seems important to create situations in and outside the school. The students should also have the opportunity to learn in practice, on placements.
European Dimension
This workshop started with an overview and in depth explanation of the course and its development. Discussion then took place regarding the evaluation of the course. Participants were asked to give feedback on their impressions of the course on the following topics: assignments, assessments, tutoring, group work, deadlines, and blackboard system. There were lively and engaged discussions. Teachers recognised that the students really did confirm that the objectives of the course had been met. In summary the group were left with some questions: more feedback is needed, how will the course be made available and how can more schools be involved in the future? The most positive outcome of the course was the very good feedback from the students and how much they valued it as a learning experience.
Peer Review
This workshop began with the progress and challenges of designing and implementing the Peer Review system. One of the institutions who had undergone one of the first pilot peer reviews presented their perspective. Following this, a personal experience was shared by one of the Enothe members who is learning how to undertake reviews. Finally Heidrun Henshel from Reutlingen, Germany outlined the Quality Review in Germany-Q Intern. The final part of the workshop addressed the question "How can we support the continued implementation of international review of occupational therapy programmes?"
The Pilot Peer Reviews
Professor Rona Howard, Coordinator- University of Salford, UK. (Read the full text..»)
An institutional experience of Peer Review
Jette Haugboelle - Naestved, Denmark (Read the full text..»)
A "developing reviewer" experience
Marie-Theres Nieuwesteeg- Biel, Switzerland. (Read the full text..»)
Q-Intern - A quality management system to be applied in OT Schools in Germany
Heidrun Henshel- Reutlingen, Germany (Read the full text..»)
Workshop: Supporting continued implementation-
Prof Rona Howard, Coordinator- University of Salford, UK (Read the full text..»)
East West South-Central European project group
During the workshop three chosen speakers from the East-West and Central project group presented up-dated information on their country to all participants. Each presentation lasted about 25 minutes. They included : 'First steps development of education in Ergotherapy in Russia', presented by Svetlana Pirogova, Head of State Medical Academy, St. Petersburg; 'Development of Rehabilitation' and 'Overview of occupational therapy teaching in Lithuania', presented by Mr. Juocevicius from Vilnius University, Lithuania and 'Implementing occupational therapy (education) in Georgia', presented by two students, Ana Arganashvili and Tinatin Kavtaradze, from Georgia. All three presentations followed the abstracts published in the ENOTHE programme. The final ten minutes were for questions and the main areas of discussion included: promotion of the occupational therapy profession; problems with dropping-out of students during the study; problems in starting a new profession and a new practice in Greenland.
(Read the full text..»)
(Overhead 9..») (Powerpoint)
Another topic discussed was the diversity in professions involved in starting OT in several countries e.g. former psychology students (in Georgia), special pedagogy students, doctors (Belarus, Lithuania, Georgia etc.), rehabilitation workers (Czech republic). The building of identity is an important issue in establishing and continuing of education in OT in many countries. Mr. Ashour presented an opinion that only OT teachers could teach new students, not other professions. Language problems and how to deal with mostly English OT textbooks and literature; in many countries students are also asked to translate. In Belarus translations are into Russian. One idea is to share translated books, building a network. Concerning empowerment of students: an example is the Georgian students; the students from East countries might be leaders in promoting OT in the future.
Occupational Science
The following discussion took place at this workshop. The O.S. Website is hidden on the ENOTHE home page (www.enothe.hva.nl/cer/os.htm). It is under 'News from the Occupational Science Group', which does not reflect what the Website is about. It was suggested that the title 'Occupational Science Website' is placed in the blue left hand column. This would be a direct link to the site. It was suggested that the ENOTHE home page could provide an introduction to ENOTHE. The news section could be linked to via the home page. (Otago Polytechnic - Dunedin, New Zealand - Journal called, 'Occupation' needs to be included.) Problem of discovering a Website via search engines - this can be increased by using Key works and the use of hidden markers. There is a need to talk about this with web designers to get it into the Google top ten. (Plus to get into as many search engines as possible). Will be English in the foreseeable future. Web pages need to be dynamic, and this can be done in various ways. Users of the webpage can do this best by filling in references in a web-based form. This would need to be maintained. Other examples could be the learning activities on the site. To link the site with the Tuning Project. Maybe useful at pre-postgraduate level. Continuity of the site is very essential. A little bit more introduction about O.S. could be added. How the concept came about and an explanation of the concepts. And to state that the site is developing. Also to amplify that the terms are ours, but are there to guide the reader. Occupation is a term used by many disciplines -we need to clarify our approach. Could journals other than Occupational Therapy/Science be used? Can there be an introduction page for teachers and students? A link for student information? Links with the terminology group could be built e.g. regarding new terms. They could include key words, as in an article.
Problem Based Learning
This workshop aimed to introduce the philosophy of the groups' approach to the PBL booklet and stories, to engage in linking the stories to theory and to gain feedback about the stories/booklet to improve user friendliness, and to explore how it might be applied to the academic environment. The workshop outlined the development of the booklet over the last three years. Then participants were asked to get into groups to discuss an extract from the booklet (to be found on the website) and finally feedback was sought on the context of the stories and the text. In summary feedback was gained which promoted further points for the project group to consider. It was helpful, thought provoking and will impact on the future working of this group.
Co-operation in European Occupational Therapy Research
The aim of the workshop is to see if participants would support having a group to co-operate within European OT research and if so how this could be structured. To be able to realize this, the needs and problems of the participants should be identified to then formulate actions that should be taken in the course of next year. Participants took five minutes to write down their needs, current problems, visions, aims, dreams, etc. with regards to the subject. Cards are laid down on the table and every-one can have a look. A summary of the ideas: 'dreams and visions': scientific conference on OT research; OT research magazine/ journal; supporting each other; don't forget the client. 'Needs': research network; database for OT research projects; co-operation with COTEC; show that OT is cost-effective. 'Structure': co-operation with disability movements; need of an OT PhD. 'Problems': lack of mentorship; islands in research. There were a lot of ideas, but most of them were not about structure.
The participants were then divided into group to discuss about concrete actions that can be taken with regards to sharing, enabling and involving. The most important answers are presented. A summary of the answers to questions that start with: 'What are the concrete actions that can be taken to share information?' There are two ways of sharing information: sharing amongst ourselves and sharing with every-one. A database would be the first priority. This would enable collaboration, IT-links, information, mentors, supervision and would avoid isolation. 'To share our know-how?' Again a database would be first priority. 'To connect people?' Start a research project under ENOTHE or COTEC. 'To enable research?' There should be post graduate studies in OT; PhD's, and Doctorate's. Courses in publishing should be given. 'To involve people?' To answer this question the aim of the network should be clarified. (This will be done in the discussion)
The discussion: maybe we should not speak about OT research, but more about anthropological research. There is a desperate need to promote OT. Ministries have to be convinced that OT is needed structurally, not only if there is money left. Where is the focus: more towards the profession or more towards the clients? Do not make to many limitations at the start of the research network, we could have a platform for everything that has to do with research. First you have to get people to be interested in research. There are in fact two discussions: one about the content and the second about how to realize a network. The network should be powerful and therefore linked to the WHO. People with disabilities have to want it. We should collaborate for power on key subjects. The funding is a problem. The funding is not the problem, there is enough money, writing proposals is a problem. We have to share information with the students in ENOTHE context, since they will be the future researchers. ENOTHE is too limited, only focused towards education; we should remember where the clients are. We should work with ENOTHE/ COTEC, why not use ENOTHE and link two more days to the conference, to not exclude people that are not in education.
The outcomes: There is a need for an OT research network, but it has not yet been defined with regards to what subjects exactly. ENOTHE is a good place to start of with, but the new network shouldn't limit itself to education.
Student Session, Dialogue with Prof. Elizabeth Townsend
Students raised these questions to Prof. Townsend: What is occupational justice specifically? What are the differences between occupational therapy and social workers from the employers' viewpoint? The practical application of occupational justice. Explain basic phenomena of occupational injustice. Are we supposed to share the world? How should OTs use their knowledge to further occupational justice?
The following issues were raised:
What "occupation" means: Action, Inclination, Identity, Meaningful activity, Job, The way we make choices in life, Demonstrate our choices, Sense of being, Freedom to choose activity that I want to do.
Occupational justice in relation to occupational therapy: To enable people to make choices and to create enabling environments, that is the main task for occupational therapists according to Prof. Townsend. Occupational justice: no single definition, process of justice.
Examples of occupational injustice: environmental constraints; handicap; occupational dysfunction is equal to occupational alienation (doing something that has no meaning for a person); negotiating with a client, stimulate discussion with a client. Cultural aspects, gender. If the person is not prepared to accept help: share hope with the person. Be open-minded. Give time to the person. Justifying therapist choice.
OT: how to analyse what the people (children, elderly, etc.) do every day, analyse day by day.
Tools which they are using: observation, asking questions, clinical reasoning, assessment (like COPM)
Stigma, problems of group of people when we use occupational justice.
Critical thinking and reflection should be in everything we do.
OT: is supposed to work with persons who want, who ask for help.
Different Ways in PBL Education-
Dr Henk Schmidt, Prof. in Psychology, Erasmus University, Rotterdam, The Netherlands
Problem Based Learning: rationale and outcomes.
The title of the presentation was changed as he realized that many of the audience were not familiar with PBL so he will take some time to explain what it is. The presentation will include: What is PBL? Why is it used in OT teaching? Some of the outcomes of the approach (research from medicine in particular). Mr Schmidt opened his presentation by describing his own experience with PBL in the early 1970's when PBL first came to Europe from McMaster University in Canada. He shows a photograph of a student group from that time (including himself as staff member) discussing a problem that had been presented to them. He presents the kind of discussion that the student group will be having, exploring the possible problems of the person presented in the case. The students work on the problem with the goal of acquiring professionally relevant knowledge or skills. Therefore the elements of PBL are: The problem comes first. Learning is self directed (the students set their learning goals and the ways for meeting these goals). The teacher supports rather than steers.
How would a PBL education affect the life of an OT student? A lot of time is spent on self-study - study from books and from the internet. In the first meeting the students discuss the problem, discussing what they know, what they don't know and set their learning goals. Some practicals are included to provide knowledge specific to the problem, The group re-meet to examine the extent of the knowledge obtained, When there is a lecture there is an expectation that the students already have some knowledge so the lecture is to deepen knowledge - often with discussions, A time for further self study follows. PBL works in cycles, usually with 2 problems per week.
Types of PBL: Group sizes may vary (often according to the money available); the problem does not always come first. Objectives may vary: focus on knowledge acquisition versus problem-solving (e.g. medical students usually start by learning - what happens when someone breaks their neck?). PBL versus Project-based Learning (where students formulate problems themselves).
Why use PBL? It is impossible to concentrate when listening for more than 15 minutes. So learning essentially is activity - we must force our students to be active. Mr Schmidt presents a problem/story regarding a boat in a bathtub for the audience to solve (only a small percentage of those present give the correct answer). This demonstrates that learning is often partial; it may not change our understanding or world perception. Learning must be an activity.
Mr Schmidt provides an example of this through a text given to students that had been distorted in the photocopying. The students with this text scored higher on a test relating to the article than students who had a normal copy of the text. What does this demonstrate: the students that scored higher had been forced to be more active readers; they had been forced to construct meaning while reading the text by having to fill in the gaps. This demonstrates that activity implies more intensive engagement in the materials. Mr Schmidt now moved on to demonstrate the importance of prior learning and knowledge. He projected a text without a title for the participants to memorize, that when read was incoherent. Participants had difficulty memorizing more than a few sentences. When the title of the piece was added the text immediately made sense and would be easier to memorize. This demonstrated how when prior knowledge had not been activated learning was very poor. This demonstrates that prior knowledge provides coherence in learning. Prior knowledge is used in understanding new knowledge. These are fundamental characteristics of the brain that should be taken into account when organizing our learning. By giving the students a problem the students are first being asked to activate prior knowledge; then they study. The activation of prior knowledge helps them learn more effectively.
Research has demonstrated that a group of students who were given a problem and then studied a text remembered 20% more of the text than a control group who had not been given the problem. A study compared the diagnostic reasoning of students from three medical schools (two with PBL curriculum and one with a traditional curriculum). All groups showed linear growth but the two PBL curriculum students showed slightly better results. Long term results: the majority of studies are from the University of New Mexico Medical School. They have traditional and PBL programmes. PBL graduates feel better prepared for professional practice and think they are better able to communicate. They showed no increase in self directed learning and spent more time with patients.
Mr Schmidt's research: questionnaires were sent to 10.500 alumni. The instrument used was a 72- item rating scale. A 40% response was received. The results were simple average scores. The questionnaire asked the alumni to rate themselves on a five point scale from 'much poorer' to 'much better' according to how good they perceived themselves to be in relation to colleagues from another university with respect to 19 professionally important skills. Some of these skills related to PBL and some were unrelated. When calculating the results it was important to correct for self-overestimation, so the self-estimation was compared with known independent information (theoretical knowledge). Conclusions showed that PBL seems, in the eyes of the graduates to live up to expectations. It may also be considered to what degree the graduates are influenced (live up to) these expectations.
Facilitator or Salesman-
Paul Himschoot, co-ordinator Quality care, Provinciale Hogeschool Limburg, Hasselt, Belgium
This workshop began with a discussion of the definition of PBL and then progressed onto a discussion on team working and links to PBL. Paul Himchoot suggested that when setting up a PBL programme you need to carry out a SWOT analysis (strengths, weakness, opportunities, threats). The topics of teaching staff, management, students, government and society were suggested in relation to a SWOT analysis. The facilities needed for PBL, the teachers' role and group processes were highlighted as the key differences that need to be addressed through socialisation into the expectations of PBL and necessary skills. Questions focused around classification of how difficulties in groups are managed, individual's difficulties with learning styles, outcomes of assessments and developing PBL. It was felt that this was a good forum for discussion for people developing PBL in OT Education.
Growing and developing-
Jo-Anne Supyk, Senior Lecturer, University of Salford, UK
In this workshop Jo Supyk outlined the added dimension of using PBL as being personal and professional development, team working skills, communication, assertiveness, and co-operation. She outlined the aim of the Enothe PBL Project Group and explained the development of the narratives in the booklet. Two student perspectives were shared. The workshop then proceeded with group work on the topic of identifying personal skills developed using PBL and also the identification of key skills required for working in teams. Discussions followed on the following topics: how do we assess these additional skills and the identification of the key themes emerging from personal and team's skills identification. This workshop went well with active participation throughout. There was an in-depth sharing of experiences, attitudes and questions on PBL.
Into the Future-
Annerie Zalmstra, Senior Lecturer, Hogeschool Zuyd, Heerlen, The Netherlands
A short introduction of the OT-programs was given:
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Participants did appreciate the advanced character of the workshop. They became more aware of their various PBL-experiences. The PBL-approaches of the schools represented were compared and there was a lot of discussion about it. Topics of the discussion were: Importance of the design of good triggers in PBL-tasks: e.g. students start with the elaboration of the occupational performance problem of the client, then a trigger is given about something that happens to the client and on which you have to intervene as an OT. Importance of clinical reasoning in the learning process of the student: students need time for in-depth top-down-reasoning. Transfer of knowledge to fieldwork: several OT-schools have their students from the beginning working on assignments in the OT-practice outside. Results are promising: this way of learning stimulates the transfer of knowledge. Use of Blackboard: Assessments: besides individual assessments schools also use group assessments with individual reflection. There are good experiences with peer-assessment. There was also talk about the influence of the age of the students on the learning process.
Outcome:
The participants would like to start a discussion forum in ENOTHE with experienced PBL-teachers / OT-schools to support each other in didactic development and to do research. As topics for a discussion forum the following issues were mentioned: Research: what is the long-term effect of PBL on the performance of the occupational therapist? EBP in a PBL-OT-program. Use of resources in a PBL-OT-program.
Using Problem Based Learning and Information Technology to Facilitate Students' Awareness of International Practices in Occupational Therapy-
David Robertson. Lecturer, The Robert Gordon University, Aberdeen, Scotland, UK.
This was a presentation of the Mary Stuart Project, which describes the potential for PBL supported by communications technology. Rationale was described and the methodology and successful outcomes also. Project partners included the Robert Gordon University (Scotland, UK) and University of Wisconsin Lacrosse (USA). Video conferences and the virtual community were described to illustrate the context of information technology. Mistakes were also discussed and used as a useful learning process. In summary this project has been inspired by Enothe, WFOT, AOTA and the COT professional bodies. The literature reviewed indicated that there is little evidence from within OT. The presentation described the outcome of this project as positive and beneficial regarding both OT and information technology.
(Read the full text..»)
(Overhead 11..») (Powerpoint)
Developing On Line Synthesis Groups to Support PBL-
Paul Wilby and Teena Clouston, University Hospital of Wales, College of Medicine, Cardiff, UK.
This presentation described a study on on-line synthesis in PBL in Cardiff (Wales, UK). Reasons for utilising technology were described including catering for larger student numbers and geographical dimensions. Opportunities were identified to maximise peer learning in the spirit of self directed learning. Historical perspectives were introduced including the interprofessional element. Research into this area was introduced including some difficulties experienced by both students and facilitators. Outcomes of the evaluation were highlighted. Social and constructed environments were also highlighted and it was found that deeper learning occurred with using "real life" contexts. The web page was discussed. In summary the presentation gave a useful historical influence and the current status of this project. Implementing the project with final year students in OT was described and evaluated.
(Overhead 12..») (Powerpoint)
Interprofessional Working in PBL-
Christopher McKenna, Lecturer, University of Teesside, UK.
This presentation described a project on interprofessional working in PBL at the school of Health Sciences and Social Care. PBL was seen as a useful tool and was used to create more realistic learning opportunities. Students' autonomy was seen as very important in this context. PBL with masters students in the allied health professions are physiotherapy, occupational therapy and radiography, with adult nursing soon to follow. Triggers will need to be familiar to all professions. Student's previous experience was also considered and how important induction appeared to be. In summary the presentation discussed the effectiveness of PBL and also introduced its potential for both uni- and inter-professional learning. Different routes of PBL were used.
(Read the full text..»)
(Overhead 13..») (Powerpoint)
Occupational Snapshots-
Fiona Douglas, Occupational Therapy Programme Leader, University of West of England, Bristol, UK.
Fiona Douglas presented a preliminary study on this topic. Prospective students were required to fill out an occupational snapshot diary and to read an article by Ann Wilcock. Early on in their education they analysed this data and then they repeated the recording exercise at the end of their first year. Results were presented and in general it appeared that first year students appeared to have a basic understanding of the importance of occupation in supporting health and well being.
(Overhead 14..») (Powerpoint)
Occupational Balance- a student's perspective on health and well being-
Helen Roocroft, University Hospital of Wales, College of Medicine, Cardiff, UK.
Helen Roocroft presented her final year project on this interesting topic. It looked at students' balance of occupations and their time spent on each one and also their perceptions of their balance of occupations and their influence on their health and well being. She presented her findings form a literature review, methodology, results and discussion. She concluded that the research did not find any literature of OT students or students' balance of occupations, only on adults. She also concluded that OT students appear to know the theory around balance of occupations and how this links with health and well-being, although only a small number appear to practice having this balance in their lives. (Read the full text..»)
Closing Ceremony-
Nils Erik Ness, Hanneke van Bruggen and the occupational therapy students from Charles University
Nils Erik Ness closed the proceedings by thanking a great number of people; for those who had organised and run the meeting, speakers, facilitators, students, the external evaluators and others. Small gifts were presented to these people by Hanneke van Bruggen and Nils Erik Ness. He also commented on how successful her felt the meeting had been and that the work of Enothe and its project groups is now certainly becoming internationally respected and known.
Closing Words-
Zuzana Dudakova, President of the Czech Occupational Therapy Association
Zuzana Dudakova offered closing words and stated how the organising committee had enjoyed having the conference in Prague and she hoped all participants had gained from being here. She invited participants to refreshment offered by the Czech Occupational Therapy Association.
Closing Words-
Maria Skourolíakou, President of COTEC
Maria Skourolíakou congratulated the organisers of the conference and thanked the Enothe Board for the invitation to participate in this event. She stated that this had been her first Enothe meeting and will not be her last. She said how impressed she had been with the enormous work she had witnessed being carried out within Enothe. She was impressed with the motivation, engagement of all the participants and the number of projects Enothe had undertaken and achieved. She also stated that she had come to the meeting to improve the co-operation between Enothe and COTEC. COTEC is at present in a transitional period, and they are changing their structure to improve efficiency, in order to enable national OT Associations to develop, harmonise and promote standards of professional practice and education of occupational therapists. She also commented on the Tuning Process and how she sees it as a great opportunity to build upon co-operation between Enothe and COTEC and to combine the educational process with professional issues. She finished by inviting all participants to Athens to the European Conference in September 2004.
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