Diferentes miradas sobre la dimensión juventud

Although Wood (2005) found a general consensus amongst British placement tutors that emerging placements should be developed, concern was raised that students could be wasting time when they should be learning the basics so that they have the skills to be “up and running as a basic grade as soon as possible” (Wood 2005, p377). Casares (2003) found similar disagreement between placement coordinators who felt that such placements were positive and posed no threat and educators who tended to believe the opposite or were undecided. However it is not stated in the paper what reasons were given or what types of questions were asked in the survey used. The finding that placement coordinators were more positive than educators about the use of such placements raises questions about whether, as

academics, they have more time to think about the future of the profession and can see the value of such placements or whether such placements are simply seen as positive in helping them secure the required number of placements.

Kirke et al (2007) highlighted concern from educators that role-emerging placements may be using up placement hours and potentially compromising clinical experiences. They suggested that such placements may also disadvantage weaker students who need more time to consolidate traditional skills. This view is held by other authors (Huddleston 1999b, Sullivan and Finlayson 2000, Fisher and Savin-Baden 2002b, Wood 2005) who suggest that not all students would be able to cope with role-emerging placements, although no evidence is offered for this conclusion. Sullivan and Finlayson (2000) consider it unethical to place a student who is unable to meet the demands of a role-emerging placement, and therefore recommend the use of a careful selection process to place students in such a placement. Such a selection process is also reported by Fleming et al (1996) who require students to submit applications for such placements. Students are then rated by staff as to their potential suitability for a role-emerging placement, for example their ability to adopt a leader role and be a team player, their creativity, problem solving and communication skills, their self- confidence and ability to manage stress. However, other authors argue that role-emerging placements offer significant opportunities for students’ professional development in these areas and should be a compulsory element of their education (Hook and Kenney 2007, Thew et al 2008).

Whilst Fisher and Savin-Baden (2002b, p279) found that amongst occupational therapy educators and managers there was some recognition of the potential value of role-emerging placements in developing qualities such as “initiative, creativity, problem solving, independence and autonomy in learning” they generally found little support for such placements. Such conflicting opinions may reflect the participants in the study, many of whom were unfamiliar with role-emerging placements and as such had no direct experience on which to base their opinions. They concluded that further research is needed to investigate these types of placement (Fisher and Savin-Baden 2002b), a recommendation also made by other authors (Fleming et al 1996, Bossers et al 1997, Casares 2003, Kirke et al 2007, Overton et al 2009).

A particular concern raised by Fisher and Savin-Baden (2002b, p278) was identity development and the belief that “OT philosophy and competence is hard enough to learn from experienced OT’s, I do not think it can be learnt from others”. This was also raised by Tompson and Ryan (1996a) who suggest that, in a profession which has difficulty with its identity, placements where there are no occupational therapists will limit a student’s opportunity to observe therapists in practice and encourage them to look to other professionals as their model for future practice. This issue of professional identity has implications for practice education where there is a need to ensure that placements provide sufficient opportunity for the development and understanding of identity, particularly at a time when an increasing focus on generic and inter-professional working requires graduates to understand and have confidence in the profession and self as therapists (Turner 2011). However, the views expressed in these studies are often in contrast to those of other authors who suggest that one of the benefits of role-emerging placements is the development of students’ professional identity (Bossers et al 1997, Prigg and Mackenzie 2002, Mulholland and Derdall 2005, Fieldhouse and Fedden 2009, Thew et al 2011).

Thew et al (2008) highlighted additional difficulties with role-emerging placements, including a lack of communication between on-site and off-site supervisors, staff attitudes towards occupational therapy, difficulties with access to support from part time supervisors and different expectations of students and university staff. Such challenges have also been reported by other placement tutors (Jung et al 2005, Hook and Kenney 2007, Cooper and Raine 2009, Edwards and Thew 2011, Thomas and Roger 2011). Similar issues were also identified by Wilcock et al (2009) from the perspective of off-site occupational therapy educators, a perspective that is largely missing in the literature. Following their experiences as placement tutors, useful recommendations have, however, been provided to help address some of these issues. These include site visits by placement tutors to ensure appropriate placement opportunities are available, identification of on-site and professional supervisors, setting out clear roles, responsibilities and expectations for all parties involved, pre- placement preparation of students and supervisors, developing students’ awareness of the relevance of skills gained in non-traditional placements, induction days for a period of time prior to the full time placement and having a full time academic tutor for role-emerging placements (Fisher and Savin-Baden 2002b, James and Prigg 2004, Mulholland and Derdall 2005, Thew et al 2008, Edwards and Thew 2011, Thomas and Rodger 2011).

In their phenomenological study that explored the ‘lived experience’ of a Canadian student on six week role-emerging placement at a homeless shelter, Heubner and Tryssenaar (1996) found that the student had a persistent struggle with the meaning of her role in the setting and the need to establish her professional identity, although it was through engagement with clients and team members that an understanding was developed. Analysis of the student’s reflective journal revealed two main themes, namely the importance of rapport building and meaningful occupation. However, these themes appear to be more reflective of the core values of occupational therapy rather than providing a more detailed understanding of the influence of the placement on the student’s development. Therefore, whilst this was the only phenomenological study identified, it lacked clarity as to whether the aim was to understand the meaning of the placement for the student or whether the journal entries were used to support the need for occupational therapy with this client group.

Concerns raised by students in a study by Prigg and Mackenzie’s (2002) include a lack of clear expectations, limited time with supervisor and short length of placement. Second year students expressed concern about a lack of client contact but appeared more anxious about this than third year students. James and Prigg (2004) also highlighted a lack of client contact as an area of student concern. Similarly, whilst the students in Bosser et al’s (1997) study viewed role expansion positively in preparing them for diverse practice once qualified, some uncertainty was expressed about whether the roles undertaken were occupational therapy (Bossers et al 1997). It could however be argued that this is not unique to students on role- emerging placements as therapists working in more traditional settings also experience this uncertainty as a result of increasingly generic roles being required of them. It is also possible that these findings reflect the student’s level of education where experienced students may be more confident in developing and applying their core skills whilst novice students may still be focused on developing knowledge and skills of specific conditions and interventions. Such findings may have implications for the timing of role-emerging placements.

Friedland et al (2001) evaluated role-emerging placements for Canadian students through the use of students’ reflective journals, pre and post placement questionnaires and debriefing sessions. Interviews and questionnaires were also carried out with supervisors. A number of themes emerged, although in discussion it was unclear to what extent a consensus of opinion was reached. Mixed opinion emerged regarding whether students should be screened for characteristics such as independence and confidence with some students feeling that this

would help them be more effective on placement whilst others felt such skills could be developed on placement, a suggestion also made by Bossers et al (1997). High levels of support were suggested as being required by students and those that felt well supported were more confident throughout the placement. Whilst the majority of the themes presented were concerns raised by the students, personal and professional growth was identified as a positive aspect of the placement although this was not explored in any detail and no specific areas of growth were identified. Friedland et al (2001) made recommendations for improving the placement experience, for example raising students’ awareness of their role in health promotion prior to placements, maintaining high levels of support, preparing supervisors, helping students to develop their professional identity and marketing skills. Such recommendations are similar to those made by other authors (Westmorland and Jung 1997, Jung et al 2005, Mulholland and Derdall 2005, Thew et al 2008, Edwards and Thew et al 2011).

Four years after this initial study was carried out Friedland et al (2001) carried out a review and identified that their recommendations had been implemented and that placement sites were increasing. However, an unresolved issue was that students continued to lack an appreciation of the importance of health promotion and of the role of occupational therapy in role-emerging settings. Students also appeared to value the development of clinical skills in traditional medically dominated settings over those acquired in community placements. Such findings have implications for the use of role-emerging placements if students do not perceive them to be an effective use of placement hours. There may be serious implications for the future of the profession if students do not recognise the role for occupational therapists outside of traditional practice settings and the contribution that the profession could make in maintaining the health and well-being of the general population (Wilcock 2006).

2.5 Research and quality assurance priorities within Occupational