20Q: Interview With A Pediatric Researcher

Anita Witt Mitchell, Pediatric Researcher

Anita Witt Mitchell, a fellow of the American Occupational Therapy Association, an active researcher in pediatrics, is currently a professor of occupational therapy at the University of Tennessee in Memphis.  She has received numerous awards for teaching and research during her tenure at the university. Her research interests include sensory processing, various aspects of fine motor development, and epistemic and ontological cognition of occupational therapy students. She has published a number of articles related to pediatrics and education in the American Journal of Occupational Therapy, Physical and Occupational Therapy in Pediatrics, Occupational Therapy in Health Care, and Occupational Therapy International. 

 

Franklin Stein, PhD, OTR/L, FAOTA

Contributing Editor

Salute to OT Leaders Series

20Q: Interview With A Pediatric Researcher

Research

1. You have published a number of research studies over your career on sensory processing disorders in children. Can you describe the methods you used and how the results of the studies have impacted clinical practice?

I’ve always had a fascination with sensory integration and sensory processing stemming from a long-term interest in neuroscience and the relationships between brain function and behavior. The first several works I published were in a related area--body scheme. In fact, my first peer-reviewed research article was a study of body-part identification in one- to two-year-old children. It was actually my master’s thesis. It was a descriptive study looking at the sequence in which young children learn to identify body parts, both on a doll and on themselves. I found that, as expected, older children were able to identify more body parts than younger children, but there were no differences in the identification of body parts on the doll versus on themselves. It also seemed that the more salient body parts like the eyes and nose were learned first.

Like other descriptive studies I’ve done, that study helped provide foundational information that occupational therapists and other healthcare professionals can use in assessment and intervention. We sometimes think that we have the research data in sort of “every-day” areas such as body part identification, but when we seek out the information, we find it’s not there. That was the case for body part identification in young children. Although those types of items were on many developmental assessments, there was a lack of research to delineate what the expectations should be at different ages.

One of the most rewarding things about conducting and publishing research is how it can help others in their work. The body part identification study has been regularly cited in a number of national and international peer-reviewed publications, including the British Journal of Developmental Psychology, Child Development, Behavioral and Brain Sciences, and Infant Behavior and Development, Frontiers in Human Neuroscience, Child Neuropsychology, and, Acta Psychologia. Although it was published in 1990, it was cited as recently as last year. Not only has it been referenced in relation to the development of young children, but it has also been cited by researchers studying the cognitive and perceptual abilities of dolphins!

My study of mature scissor skills arose from a similar situation. Although textbooks often describe mature scissor skills, and fine motor assessments often include scissor skills, our study was the first to document the characteristics of mature scissor skills and the influence of task and tool characteristics on mature scissor skills. Our research team videotaped adults cutting different shapes with two different types of scissors and described different aspects of adults’ grasp and use of the scissors. We found that there were variations in grasp and cutting motions, depending on the type of scissors and the shape being cut. Like the study of body-part identification, that study provided foundational information for OT assessment and treatment that had been previously taken for granted. It was another area where we assumed we had the research to back up what the textbooks told us, but we actually did not. In addition, that study provided some insight into how the task and tool characteristics can influence our movement patterns. Again, it is gratifying to be able to help others through contributions to research. For example, the scissor study prompted correspondence with a researcher in South Africa who used it to inform her work developing motor imagery training for children with Developmental Coordination Disorder.

I’ve also collaborated on descriptive studies of young children as they begin to crawl and how their goal-directed actions and angry behaviors increase as they begin that developmental milestone. While studies of intervention effectiveness are definitely important to our profession, I think we also need to remember that descriptive studies can play an important role in evidence-based practice as well. They are certainly a basic foundation as we develop knowledge around a topic, but they are also vital to assessment as well as for directing intervention.

In terms of sensory processing, though, I also had an opportunity to conduct a systematic review related to sensory processing disorder, with the help of a group of students. In 2007, Lucy Miller and a team of experts in sensory processing developed a new way of classifying sensory processing disorders. I wanted to see if the literature supported the classification system, specifically for 0- to 3-year-olds who were born preterm, so we looked at descriptive studies from a variety of disciplines to determine whether there was evidence of the different types of sensory processing disorder they described. We found that it was at least somewhat supported, particularly in terms of sensory over-responsivity. I think this study contributes to OT in a number of ways, for example, as at least a partial validation of Miller and colleagues’ classification system. I think it also provides some justification for screening young children who were born prematurely for sensory processing disorder and for educating parents of infants born prematurely about sensory processing disorders, as well as for supporting environmental modifications in the NICU. To date, it has been a highly cited article, internationally as well as nationally.

I enjoyed conducting the systematic review, and it was rewarding to contribute evidence at the “top” of the evidence pyramid, but it’s also possible to conduct simple case reports that can test theory to some degree. Earlier in my career I had an opportunity to write up a case report for one of the AOTA Special Interest Section Newsletters that illustrated how Warren’s Hierarchy of Visual Perception could be—and did--apply in pediatrics. It concerned a child that I worked with who had visual problems at all levels of the pyramid that Warren had developed to describe visual perceptual impairments in adults with brain injuries. After a period of time working with a developmental optometrist and addressing the child’s needs at the lower and middle levels of the pyramid, he made gains at the higher levels, including in the areas of visual cognition and visual attention. I thought it was important to share that story with others in the profession, even though it was not a full-blown research study, in hopes that others might be encouraged to study the application of Warren’s theory in pediatrics. In fact, textbooks such as Kramer and Hinojosa’s Frames of Reference for Pediatric Occupational Therapy and Case-Smith’s pediatric textbook later included the Warren pyramid in their chapters on pediatric visual perception.

All in all, I hope my contributions have helped further the work of others, and that they have provided some of the foundations needed for evidence-based practice in OT. I think they illustrate how studies at all levels of evidence can be beneficial to our profession.

2. Critical reasoning in occupational therapy students has also been a focus of your research. How did you first become involved in this area and what have you learned from your observations and findings?

Once I became an educator, it didn’t take long before I began to observe students struggling, and I wondered how I could do a better job of helping them. I always thought it was helpful for students to explain why they approached a problem a certain way, or what their reasoning was for the way they answered a question. It was helpful to me as I tried to understand where they were having a problem, and I think that process was what lead to my interest in critical reasoning.

Along the way, I had an opportunity to conduct a study in which I explicitly taught students about critical reasoning and asked them to reflect on their reasoning as they completed a case-based assignment. One of the things that the study did for me was that it confirmed the importance of using case-based learning and providing guiding questions and feedback to facilitate more complex or sophisticated types of reasoning. In their reflective journals, the students talked about how the case-based questions required them to consider certain information in the case and to respond with particular actions. As educators, when developing case-based assignments, we can intentionally design questions that will lead students to focus on specific information and to take specific actions that might facilitate the kinds of reasoning students need to work on. For example, questions could be directed explicitly to emotional or contextual issues in the case or students could be directed to the OT Practice Framework as a way of learning about resources and tools for reasoning.

I think the study also demonstrated the importance of student reflection because many of the students talked about how they weren’t aware of the different kinds of reasoning or how they were reasoning. Reflective journaling about critical reasoning made them more aware of the types of reasoning that came more naturally to them and how they needed to make an effort to reason in other ways. Since our program routinely had the students take the Watson-Glaser Critical Thinking Appraisal, we were also able to look at the differences in reasoning for students who scored lower on the assessment. It did seem like those students needed more guidance and feedback in order to utilize the variety of types of critical reasoning. I think that study can also remind us of how important it is to be reflective practitioners, and that it might be helpful to actually reflect on the metacognitive aspects of how we are thinking about a client.

When I started my doctoral work, I was thinking that critical reasoning would be my focus, but then I learned about epistemic and ontological cognition, or EOC, and it seemed to fill in some “holes” for me as I was trying to promote students’ reasoning. EOC has been studied by educational psychologists for many years, but I hadn’t heard of it much. Ontological cognition relates to beliefs about the nature of knowledge. It exists on a continuum, with less sophisticated thinkers (so to speak) believing that knowledge is certain, unchanging, and simple. At the more sophisticated end of the continuum is the idea that knowledge is complex and integrated, and that it changes as we learn more about a topic. Epistemic cognition, or beliefs about the source and justification of knowledge, also exists on a continuum. At the less sophisticated end, is the belief that there is an omniscient authority who is the source of knowledge and can provide “the answers.” At the other end of the continuum is the person who believes we need to use multiple sources of knowledge, for example, authorities or experts, our own experiences, contextual information, and logic and reason, to determine the best solution to a problem. It’s the idea that there isn’t a cookbook answer (which students are often looking to instructors, textbooks, and supervisors to provide), but rather, “it depends”—which is an answer that students usually hate!

In my dissertation, I studied EOC, from a cross-sectional standpoint, comparing incoming students to students at the end of the didactic part of our program, as well as longitudinally, following a group of students from the beginning to the end of the didactic part of our program. In the cross-sectional study, there was evidence that the post didactic students had more sophisticated EOC in relation to OT-specific knowledge than the entering students, and this makes sense. The students did seem to shift away from the idea of simple, certain answers justified by an authority figure toward a more sophisticated view of knowledge, but they still had not fully and consistently developed the most sophisticated levels of EOC, even in relation to OT knowledge. In the longitudinal study, I only looked at EOC related to knowledge in general, and the findings were a little different. In that study, there were no differences in ontological cognition, but there were in epistemic cognition. That is, in terms of general knowledge, the students’ beliefs in justification of knowledge by an authority figure were weaker by the end of the didactic part of the program.

Tying this back to critical reasoning, it makes sense that if students believe that knowledge is simple and certain, they may tend to focus on the types of reasoning that are more simple and certain. For example, this might be more scientific and procedural reasoning about the diagnosis and standard procedures and protocols, rather than including more pragmatic and narrative reasoning and using contextual information and information from the client to determine how the diagnostic and procedural approaches might or might not apply in a given situation. To reason like an expert, students need to be able to consider multiple sources of knowledge, and this requires more sophisticated beliefs about the source and justification of knowledge.

Because of these apparently logical ties between critical reasoning and EOC, I did a study to test this connection. Again, it is surprising that there is not a lot of research looking at this, even outside of OT. What I found was that OT students who had stronger beliefs in an omniscient authority as the source of knowledge were more likely to have lower scores on the Watson-Glaser. Again, it makes sense that if someone believes an authority figure can provide the “right” answer to a problem, there would be little need to reason critically. There is some evidence from other disciplines that using constructivist approaches that help students question their own beliefs and approaches to reasoning may be useful for promoting more sophisticated EOC, but we need more research on this in OT. Using methods like collaborative assignments, debates, reflection, and case-based methods may help facilitate more sophisticated EOC, and those instructional methods are pretty common in OT education.

Clinical Practice

3. Have you been able to engage in clinical practice while teaching at the university?

I did for several years until faculty shortages and increasing workloads. I also worked to transition the program from a bachelor’s to a master’s program and developed a distance video conferencing program so it made it difficult to have the time. Before that, I provided assessments and consulting services to the UT Boling Center for Developmental Disabilities and the LEND (Leadership Education in Neurodevelopmental and Related Disabilities) program where I had worked before becoming a full-time faculty member. I also worked at a program called Kids & Nurses, which was essentially a daycare for medically fragile infants and young children. It was a similar thing to working in a NICU or transitional care unit but in a community setting. I did hold board certification in pediatrics through AOTA from 1993 to 2006, but I haven’t been in formal clinical practice for several years now. Before the pandemic, I volunteered with a program for Latino families who have children with disabilities and for a summer literacy program.

Current Research

4. What research studies are you currently engaged in and planning to carry out?

I have continued my work related to EOC by collecting data to investigate changes in EOC during fieldwork. I collected quantitative data for several years, but I haven’t been very successful in getting students to respond once they are off campus. I do have some qualitative data that I plan to analyze in the next several months, though. I’m also collaborating with faculty members at Florida A&M University to look at student self-efficacy for learning hands-on skills in an online format due to the pandemic, and a colleague and I are currently finishing a manuscript describing our study of the use of a serious game for teaching and learning.

I was collaborating with a faculty colleague and a pediatric neuro-ophthalmologist to collect data for a study of interventions for children with cortical visual impairment, but we had to suspend the study due to the pandemic. I am collaborating with the same faculty colleague on a scoping review of OT assessment and intervention for children with CVI, and I am collaborating with other faculty members on a few small grant proposals related to parent training for kindergarten readiness.

5. Are you working actively with students on research projects?

Not currently, but I have in the past. Some of them have been published, for example, the sensory processing disorder systematic review, the scissor skills study, and a survey of OT programs’ teaching related to play.

At one time, faculty mentoring of student research projects was part of our research curriculum, but a few years ago I took over that part of the curriculum, and we transitioned to an evidence-based practice approach. Now we focus on teaching our students evidence-based practice and data-driven decision-making skills, and they learn research design as part of the necessary knowledge for appraising literature for evidence-based practice. Ultimately, our students work with local practitioners who serve as content experts and mentors. As a capstone experience, students go through the steps of EBP to answer a question posed by the practitioner mentor and present posters, usually at the mentor’s facility, but this year it was done remotely via VoiceThread.

This seems to be a successful approach in many ways. Students are very complimentary of the courses and talk about how they are transformative in terms of their scholarly development. I think they are also helpful for the practitioners, not only in terms of answering their practice questions, but also for modeling the EBP process and providing suggestions for knowledge translation. The students have also presented their posters at state conferences, and one group presented at a regional burn conference. Last year, a student team developed and submitted a manuscript based on their project to a peer-reviewed journal, and another team submitted an abstract and their poster to a U.S. Senate subcommittee investigating fall prevention. We now also have an opportunity to disseminate the posters through the UTHSC Digital Commons. Of course, if and when we transition to the OTD, we will resume faculty-mentored research projects.

Publications

6. One of your recent publications is on evidence-based education in occupational therapy. What were the concepts that you presented in the book chapter?

I was invited to contribute a chapter on evidence-based education in occupational therapy in Ted Brown and Bret Williams’ edited book, Evidence-Based Education in the Health Professions: Promoting Best Practice in the Learning and Teaching of Students. In the chapter, I reviewed the state of evidence-based education in OT using a framework presented by AOTA in 2009. AOTA described the Scholarship of Discovery, the Scholarship of Integration, the Scholarship of Application, and the Scholarship of Teaching and Learning. The Scholarship of Discovery was defined as research that seeks to produce and advance new knowledge in order to develop theoretical perspectives. A lot of the research related to critical thinking in OT would fall into that category. AOTA described the Scholarship of Integration as integrating knowledge from OT with knowledge from other disciplines. I think my work on EOC could fit in that category because it borrows concepts from educational psychology and applies them in OT. Then there is the Scholarship of Application. This is the type of research that looks at developing instructional approaches and methods. Research on the use of different types of case-based methods would fit in the Scholarship of Application. The Scholarship of Teaching and Learning refers to rigorous studies based on theoretical frameworks and looking at the effectiveness of instructional techniques and approaches. Our study of a serious game for reviewing qualitative research concepts would fit in this category.

Using these categories helped me to organize the research that has been done in OT education and get a sense of where we are in terms of our evidence-based education practices. At the time, it seemed like a lot of the Scholarship of Discovery in OT was related to critical thinking, but we probably need more Scholarship of Discovery and Scholarship of Integration to develop a cohesive, comprehensive theory or framework for OT education. Barb Hooper and her colleagues have been working in that direction for the last few years, so that may emerge before too much longer. There has also been quite a bit of Scholarship of Application, especially in terms of approaches like case-based and problem-based learning, for example. Since I wrote the chapter, the Scholarship of Teaching and Learning has increased, largely due to initiatives like the AOTA Education Summit, the AOTA Scholarship of Teaching and Learning Program, and the establishment of the Journal of OT Education. I think these developments have raised the profile of OT education and its recognition as a practice area. The Ed Summit and JOTE have certainly provided venues for easier dissemination of educational research in OT.

In the book chapter, I also provided recommendations for future research in OT education, including the need for larger, more rigorous, and cross-institutional studies. We also need to develop approaches for studying the effects of instructional methods on performance in fieldwork and practice, or at improving students’ skill at serving clients. The use of simulation in OT education may provide more feasible ways of doing that.

Background

7. Where did you grow up, go to school, and what was your childhood like?

I grew up on a farm in southeast Missouri, and I went to elementary school in a small town about 6 or 7 miles away from where we lived. We were in the country, and we didn’t have neighbors nearby. I spent a lot of time playing outside by myself, exploring around the farm near our house, catching tadpoles, walking down to my grandmother’s house down the road to visit with her, and playing with our cats and dogs. I started reading before I was in kindergarten, and I don’t really remember learning to read. I may have picked it up when my mother was helping my older sister, but I always loved to read, especially fairy tales. I had two best friends whose families were also farmers. We didn’t live near each other, but we spent the night with each other, played together at recess at school, and celebrated birthdays together. I went to the middle, junior, and high school in the slightly larger town about 5 more miles away from where we lived. I was in the band, played piano, and belonged to lots of clubs including the pep club that was in existence when my mother went to school there! I was actually the valedictorian of my high school class.

Occupational Therapy

8. How did you become interested in occupational therapy?

I was always fascinated by the brain and how it works and influences behavior. I didn’t know, though, what profession that might translate to. I knew I didn’t want to be a physician, a nurse, or a psychologist. I didn’t think I wanted to be a physical therapist or a speech pathologist, but I had never heard of occupational therapy. There were no OTs in the small towns near where I grew up. I went to Purdue my freshman year because they had some neuroscience programs, and there I had the opportunity to go through a career counseling program. That was the first time I had heard of OT, and it was what I was looking for, although I didn’t really understand how well it incorporates my love of neuroscience. I think that is why I was attracted to sensory integration theory because it allowed me to study neuroscience and the relationships between brain function and human behavior.

9. Where did you obtain your occupational therapy education and advanced degrees?

Since Purdue didn’t have an OT program, and I am from Missouri, I transferred to the University of Missouri in Columbia for my bachelor’s degree. Back in those days, we were able to practice with a bachelor’s degree. After I practiced for several years, I felt like I needed to learn more so I looked for a program where I could study occupational therapy with an emphasis on sensory integration. I decided on Boston University, where I earned a Master of Science degree with a specialty in pediatric occupational therapy. I was able to study with Sharon Cermak, Jane Koomar, and others with expertise in sensory integration. It took a while before I was ready and able to start my doctorate. In fact, I didn’t start my doctorate until 2008, nineteen years after receiving my master’s! In the interim, I gained teaching and scholarly experience as an educator at UTHSC, and I was married and raised a family. I think at that point I was finally in a place where I was ready to focus on a doctoral degree, and I received my PhD in Educational Psychology and Research, with a concentration in research, at the University of Memphis.

10. Who were your mentors during your education and career?

I never really had a long-term, formal mentor, but there have been many people who have influenced me along the way. In my early career, the experienced occupational and physical therapists at my first job were my first mentors. I also had the opportunity to attend a 3-week SI course at the Cincinnati OT Institute, studying under Ginny Scardina, Joan Dostal, and Elizabeth Newcomer. When I decided to go back to school for my master’s, they were the ones who influenced me in terms of where I should go. While I was at Boston University working on my master’s, Sharon Cermak and Wendy Coster mentored me, and Shirley Stockmeyer, one of the physical therapy faculty members, was a role model for me in her approach as an educator and how she had us dig into the literature and apply it to practice.

After I received my master’s, I took a job at the local LEND program (they were called University Affiliated Programs at that time), and I was the Chief (and only) OT. My mentors there were from nursing (Faye Russell) and psychology (Laura Murphy). They invited me to be part of the programs and projects they were working on, and they guided me and taught me a lot. Dorothy Anne Elsberry was the program director of the OT program at the time, and she mentored me in terms of beginning to do some teaching and getting involved with the OT program. Susan Meyers was the program director who encouraged me to apply for a faculty position at UTHSC, and she was definitely a mentor for me at that time, but she didn’t stay with the program that long. After she left, Ann Nolen, Rosemary Batorski, and I kind of mentored each other, since we all had limited experience in academia.

Once I started graduate school, my primary mentor was Denise Winsor. She’s the one who introduced me to EOC, and I did an independent study with her that shaped my dissertation. Most recently, I’ve had what I would consider a group mentoring experience through AOTA’s Scholarship of Teaching and Learning program. Our group included Bernadette Mineo, Carla Chase, and Diane Long. Bernadette, who passed away this year, filled the mentor role in the beginning, but as we continued working together, we all kind of mentored each other. Over the last few years, I have begun to act in a mentoring role for new faculty as well.

11. What was your first position in occupational therapy?

My first job was as a staff therapist at Les Passees Children’s Rehabilitation Center here in Memphis. It was an interdisciplinary outpatient early intervention program that included a preschool for children with disabilities. It was a wonderful learning experience, and I gained so much from so many of the professionals who worked there, as well as from the children and families I worked with. The administration also supported me in learning more about SI, for example, providing financial support for attending conferences and allowing me to start an after-school program for children with sensory integration impairments. While I was there, I also had the opportunity to help influence the Shelby County School System by advocating for one of my clients. He had been denied OT services at school, and in fact, the school system did not have an OT. The child’s parents proceeded to a due process hearing, and I was asked to testify. The ruling was in favor of the client receiving OT services at school, and as a result, the Shelby County School System hired its first occupational therapist.

Faculty

12. What other clinical experiences have you had?

While I was at Les Passees, I also did contract services in rural schools in Arkansas and Mississippi as part of my job. That gave me the opportunity to work with older children in an educational setting and to gain experience in more of a consultative role. That was before the days when the emphasis was on inclusion, so they were more self-contained, small schools for children with disabilities. While I was getting my master’s degree, I also worked at the Boston University Children’s Clinic where I saw school-aged children with sensory processing dysfunction on an outpatient basis. After I received my master’s, I returned to Les Passees for a couple of years, eventually taking the Chief OT position. I decided I wanted to take on some different challenges, so I then took the position of Chief of OT at the Boling Center for Developmental Disabilities. As I mentioned earlier, it was a University Affiliated Program, which is now a LEND program (Leadership Education in Neurodevelopmental and Related Disabilities). Our primary purpose was to train leaders in interdisciplinary practice. I began to have more opportunities to be involved in innovative programs and to become involved in teaching. In fact, part of my job responsibilities included teaching in the UTHSC OT program. After a couple of years, the OT program needed faculty, and Susan Meyers suggested I apply for a full-time position with the faculty. As I mentioned, I continued to work at the Boling Center after joining the faculty, primarily providing assessments of school-aged children and making recommendations and referrals. I also mentioned earlier that I did faculty practice at Kids & Nurses, the daycare for infants and young children who were medically fragile.

13. How would you define occupational therapy to a new graduate student?

I like to focus on the word occupation since that is where a lot of confusion about the profession comes from. I stress that occupation is more than a job, it is referring to those things that occupy our time and make our lives meaningful and purposeful. I stress how OTs help people at any stage of life who are having difficulty performing the everyday occupations of living. We collaborate with clients to improve their skills and/or modify the activity or task or environment so the individual can be successful, despite cognitive, physical, or mental health impairments.

14. What is your teaching style like?

I believe in active and self-directed learning, and I try to use a variety of creative assignments and activities to facilitate student engagement. I think it’s important to explain foundational information, but students need to use the knowledge they are gaining to problem-solve in some way for it to “stick” and for them (and me) to see if they really do understand. I also believe that learning is deeper and longer-lasting if it is effortful. I am often concerned that students today seem uncomfortable with struggling or grappling with the material—they often want things to come quickly and to master content easily. “Struggle is part of the learning.” Is one of my mantras! At the same time, I also like to insert a sense of humor or playfulness when I can.

I believe that feedback, instructional guidance, and scaffolding are essential for helping students develop critical thinking skills as they practice increasingly complex and creative reasoning. I try to provide opportunities for students to practice reasoning in situations of ambiguity and uncertainty to promote the development of a belief in knowledge as fluid and contextual. Throughout my teaching career, I have provided this challenge and ambiguity through writing assignments, reflection assignments, discussions, and case-based methods. I think that student collaboration has many benefits as well. I utilize recursion, for example, by introducing concepts and processes of research and evidence-based practice in the students’ first EBP course, revisiting and delving deeper into research methods in the second EBP course, and then requiring deeper integration, analysis, synthesis, and application of those concepts when students revisit the processes and concepts of EBP as they practice the skills and abilities in a real-life context in the third EBP course. They are also challenged to learn the skills necessary for the dissemination of professional knowledge in the third course.

I strive to be responsive to evidence of the need to adapt and revise my courses as well. It is amazing to reflect on the changes in teaching and learning over the years that I have been an educator. When I began teaching, we used overhead transparencies and slides as our audiovisuals—a far cry from where we are today! Transitioning to an online and remote teaching and learning format has required an enormous amount of adaptability, but it has also been enjoyable in many ways. It has stretched me in terms of creativity, problem-solving, perspective-taking, and appropriately utilizing technology to develop engaging and challenging courses that promote learning.

15. During this pandemic, how have your students coped with the stress and changes?

For the most part, I would say that they have been very patient, understanding, fairly flexible, and overall, resilient. At the same time, everyone’s baseline level of stress seems to be higher because of the pandemic, and this exacerbates the stresses that come with being an OT student. I think it’s hardest for those who are parents of young children who have the added demands of supervising their children’s online learning as well as their own. For single parents, it can be overwhelming. For everyone, I think the hardest thing is not knowing how long the current situation will continue; the uncertainty is very hard. Many of our students tend to be social people who thrive with face-to-face interaction, so it is hard for them to adjust to the limited in-person interaction with the faculty and fellow students.

16. What are the trends in occupational therapy education?

Active, engaged, experiential, and cooperative learning have been trends in education for a while now. The flipped classroom model is also a popular approach. In the flipped model, students review the basic material before class through readings or video presentations, and during class, there is discussion and application of the material. Simulation is also popular in healthcare education now. Using high-fidelity mannequins and standardized patients to simulate practice situations is used to help students learn practical skills as well as communication skills and other “soft” skills. In OT education, Hooper and her colleagues have been working to define the signature pedagogy for OT. They call it a subject-centered approach that emphasizes connections between the subject, which of course for us is occupation, and the learner and it emphasizes co-construction of knowledge. It will be interesting to see how that develops in the future.

As I mentioned before, I think that the AOTA Education Summit and the fact that we now have a journal dedicated to OT education will help us make strides toward being more evidence-based in our educational practices. I think there is often a lack of appreciation for the challenge of keeping up with both educational research literature and professional research literature. Of course, the move toward the OTD is still something that the profession is debating. Whether we eventually have a mandated doctorate remains to be seen.

Future of Occupational Therapy

17. What are the significant issues facing occupational therapists today?

As always, I still think just the PR challenge of people knowing who we are and what we do. Another ongoing challenge is the payment system and changes that seem never-ending. I think a third challenge is one that relates to those two, and that is evidence-based practice and knowledge translation. The more we can gather evidence of our unique contributions and our unique value as OTs, perhaps the more people will become aware of OT, and the easier it will be to justify payment.

Of course, the pandemic has created new challenges for our profession, for example meeting the needs of individuals who are severely affected by COVID, and challenges related to telehealth. Despite these challenges, I think there are so many practitioners in our profession who have creative and innovative ideas, that OT will continue to be a flexible and resilient profession.

18. How can we generate more research in occupational therapy?

That is an excellent question, and I wish I knew the answer! Of course, research funding is an issue, and the profession needs to continue to do what it can to promote the training and mentorship of researchers who can design the studies and write the grants that will move OT forward. Academic-practitioner partnerships are key, but they can be difficult to develop and maintain with the different demands we all face. Perhaps a move to the OTD would help, but of course, a practice doctorate is not the same as a research doctorate in terms of preparation as a researcher.

19. What do you foresee in the future of occupational therapy?

I think there are lots of opportunities to show our distinct value, but we all need to be advocates for our profession. OTs are very creative, and our broad approach and philosophy are very flexible and applicable in so many ways. It is an exciting profession, and there are limitless ways to apply our knowledge and skills to promote health and well-being.

Summary

20. How would you summarize your contributions to the profession of occupational therapy?

I would like to think that I have contributed in terms of evidence-based practice. It’s not that I have conducted RCTs or a lot of effectiveness research, but all research contributions add to the knowledge base. Adding to our foundational knowledge provides a base on which others can build, and we can grow our evidence. For me, the most gratifying aspect of conducting research is when it helps others inside and outside the profession further their work. You never know what your work will ultimately contribute to, for example, the way my master’s study has contributed to studies about dolphins!

In addition to the research I have contributed, I have also tried to promote evidence-based practices in others. I have taught evidence-based practice to students and practitioners alike, and I think that currently, with our evidence-based practice curriculum, we have the opportunity to help practitioners learn more about how to use an evidence-based approach as well as to answer their specific practice questions. I think it is very important that our students develop self-efficacy for searching, reading, appraising, synthesizing, and using evidence in practice, and I think we give them a good foundation for that. Perhaps by de-mystifying research a bit, they will also be more open to the idea that they may conduct research someday.

References

Mitchell, A. (2015). Evidence-based education in occupational therapy. In: T. Brown & B. Williams (Eds.), Evidence-based education in the health professions: Promoting best practice in the learning and teaching of students (pp. 375-388). London: Radcliffe Publishing.

Mitchell, A.W., Hale, J., Lawrence, M., Murillo, E., Newman, K., & Smith, H. (2018). Entry-level occupational therapy programs’ emphasis on play: A survey. Journal of Occupational Therapy Education, 2(1).

Nash, B. H., & Mitchell, A. W. (2017). A longitudinal study of changes in students’ perspectives of frames of reference. American Journal of Occupational Therapy, 71(5), 7105230010.

Zachry, A.H., Chappell, L.H., Cox, V.H., Lopez, E.H., Mitchell, A.W., & Woddard, L. (2015). Differences in the angry behaviors of precrawling and crawling infants. Journal of Education and Human Development, 4(2).

Mitchell, A.W. (2015). A longitudinal study of occupational therapy students’ beliefs about knowledge and knowing. American Journal of Occupational Therapy, 69(2), 1-8.

Mitchell A.W., Moore E M., Roberts E.J., Hachtel K.W., Brown M.S. (2015). Sensory processing disorder in children ages birth–3 years born prematurely: A systematic review. American Journal of Occupational Therapy, 69, 1-11.