There is an obvious need for equality during placement (Brown et al, 2006) and as has been previously suggested it could be hypothesised that there is an expectation that OT practice educators are enthusiastic to work with students with additional support requirements, given their professional philosophy and skills (Hirneth and Mackenzie, 2004).
Very little has, however, been written in terms of OT students or other allied health students with disabilities experiences during practice placement (Hill and Roger, 2016). Brown et al (2006) completed a phenomenological qualitative pilot study exploring the experiences of health professional
students during their placements in Australia. The participants were recruited from one university and data gathered using semi structured face to face interviews. Reflections and observations were recorded to increase the credibility and rigour of the study, whilst enhancing data analysis. Potential participants were required to have completed at least 1 practice placement and have a self-disclosed disability.
Ethical approval was gained and 10 students expressed an interest in participating but only 5 consented to participate. Of the 5 students one was male, 2 were nursing students and 3 were OT students. The participants had a range of disabilities that included hearing loss, dyslexia, cystic fibrosis and bipolar disorder. They had completed between 1 and 8 placements.
Data was analysed, via coding and 3 themes identified. However, little information was provided regarding data analysis and how the themes were therefore identified. The themes identified were the impact of their disability, including barriers and strategies for overcoming these, the practice placement experience and the support from the educator, friends, family and university staff. As an Occupational Therapist reviewing these themes, I again, saw the potential dynamic interaction between the person, the environment and the occupation of participation in practice education. This further fuelled my desire to consider if there would be a similar interaction for the participants in my study.
Each student described their unique experiences. Students reported needing to be highly motivated to succeed. As in previous studies they also expressed concerns regarding disclosure and attributed this to a perceived lack of
knowledge and awareness by educators, university staff and peers. However, Sivanesan (2003) believed that honesty about her visual impairment, when undertaking practice placements, was key to her success. This can also influence the individual’s perception of their identity. This study sought to explore the participants experiences of disclosure.
Brown et al (2006) described how participants had personal strategies to overcome barriers in placement such as preparation and planning. The importance of adapting to their own limitations, having a positive outlook and using personal coping mechanisms was also considered. It was also evident that these participants did not believe that the barriers they experienced impacted negatively on their performance from a competence perspective, and this view is echoed by many (Maheady, 1999; Sivanesan, 2003; Velde et al, 2004). My objective was to understand how the students within my study
viewed their placement experiences, exploring the factors they perceived to have enabled or hindered their experiences.
When asked to describe their feelings about practice placements, participants in the study by Brown et al (2006), identified ‘nervousness, apprehension, uncertainty, worry and anxiety’ (p35) with 2 participants reporting feeling excited. One participant emotively described ‘surviving placement’ (p35) and the feelings of ‘dread’ (p35) about another one. The support from the
placement educator was described as ‘pivotal’ in developing confidence, reducing anxiety and developing coping strategies. Similarly, Sivanesan (2003) highlighted the role of the educator as crucial to her development, whilst an OT student. She described a naivety from one of her educators who she felt became overprotective and treated her like a patient, but others were ‘open minded and flexible’ (p569) enabling independent working and
autonomy. Further, supporting the need to explore the experiences of practice placement from the perspective of OT students with disabilities in the home university.
In contrast to the studies by Jung et al (2014) and Velde et al (2005)
participants within Brown et al (2006) indicated that they had little contact with wider university disability support systems. However, they proposed similar recommendations.
The small pilot study conducted by Brown et al (2006) has its limitations including the potential for recruitment bias. There were only 3 OT students included within the study and in-order to maintain confidentiality and anonymity it is impossible to identify if any specific trends can be noted as applicable to OT specifically.
A further study conducted more recently compared the experiences of disabled and non-disabled student during their practice placements (Hill and Roger, 2016). The study did not include any OT students, but did include students on other health and social care courses such as medicine, nursing and social work. The results of the study identified that both disabled and non-
disabled students experienced some similar difficulties during their practice experiences. However, the difficulties experienced by those with disabilities were exacerbated by their impairments. Supporting the findings of Brown et al (2006), disclosure proved challenging for those who participated in the study, but this was eased with the support of the practice educator. Supporting previous research, Hill and Roger (2016) also identified that those who were entering a profession underpinned by the medical model e.g. nursing or medicine were more reticent to disclose. Hypothesising that this was as a result of their fears of identifying ‘with a disability label’ (p1216).
Understanding disability and disclosure from the OT student perspective was deemed important and therefore explored within this study.
Archer (1999) wrote of his personal experiences as an individual with
Attention Deficit Disorder (ADD), dyslexia and a hearing impairment studying OT in the USA. Archer provided an account of his journey, including his expulsion from his OT programme following failure within a practice
placement and prior to being diagnosed with ADD. His dismissal was linked to an inability to demonstrate clinical reasoning, problem solving and to think on his feet.
Archer (1999) identified the disparity in expectation, when it is the student’s responsibility to request adjustments but the student is unaware of their disability. He was unaware of his ADD diagnosis when he originally enrolled on the OT programme.
Archer (1999) articulated differences between the university environment and that of the practice environment. As an academic high achiever, Archer (1999) felt he had learnt to compensate for his ‘weaknesses’ (p69). However, within the practice environment he described feeling overwhelmed, with difficulties organising and retaining information, with limited time and an expectation of speed. Botham and Nicholson (2014) suggest that there is a greater level of experience of making and applying reasonable adjustments for individuals with disabilities.
Archer (1999) described how his expulsion from the OT programme destroyed ‘the image of OT as a caring profession’ (p71). Following the diagnosis of ADD, Archer (1999) fought hard to understand his own needs and developed strategies that provided structure for his learning and demonstration of his skills in practice.
Archer battled for reinstatement and with support was able to return to studies. He expressed disappointment at the system but recognised how he felt better equipped to return to study with structures, strategies and
adjustments in place. Archer’s personal account was documented almost 20 years ago and therefore it was important to explore the current day
experiences of OT students with disabilities in the UK.