The journey theme considers topics of discussion that show how the participants reflect on the concept of developing over time. It deliberately does not include the code of skills as although the participants reported that these had developed (clinical skills especially) that this was something that they had to take a much more active role in. The code of skills is therefore considered under the theme of ownership instead. All seven participants discussed subjects that fit into the codes that group together to form the theme ‘journey’ and there are 116 references in the data to this theme. It was clear that the journey started even before people started their occupational therapy education and continued after the preceptorship year, and was, therefore, part of a continuum (see figure four).
5.5.1. Before and during university: starting the journey.
The Journey towards becoming an occupational therapist starts before formal education has commenced at university. This would be congruent with theories in the literature about pre-formed ideas and socialisation (Billington, Hockey et al. 1998, Jenkins 2014).
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Four of the participants described meeting either an occupational therapist or someone with a close connection to an occupational therapist which helped them make the initial decision to enter into the profession.
This journey, towards becoming an occupational therapist, appears to really start in earnest in university with P4 describing it as such when she recalls a conversation with one of her lecturers at the end of her course. He helped her reflect on the changes she had made and describes her transformation as an ‘immense journey’, a statement that resonated with P4. It is P5 that claims a specific aspect of the university course helped her develop, talking about practice placements P5 states:
“I always got more from my practice placements that I did from Uni and I'm that kind of learner, if you show me something and I do it I will remember it “.
The preparation received at University for working life was viewed differently by different participants within the data. However, it did appear to prepare people for working in a challenging organisation such as the NHS. P2 sums this up by stating:
“The training . . . says to you . . . that change can be positive and negative . . . that it’s a flexible thing . . . and you know that’s reflective of everything in life isn’t it really”.
It was the view of one participant that what the individual takes out of university is dependent on the student. P7 claims that some students left unprepared for working life. P3 recognised that the journey was always meant to continue though saying that by the time you leave university, “you don’t really own anything” going on to discuss how after university you begin to do things in real life and that helps with the development of skills and confidence .
5.5.2 The ‘real world’.
The concept of working in the real world and trying things out on real people was an issue voiced by the participants as being one that gave confidence but also provoked some anxiety. For some doing the job helped them: “immerse themselves in their OT identity” (P7) and for others, it was recognised as a learning curve (P4 and P5).
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P5 initially sees working as a newly qualified occupational therapist as an extension of being at university, and this view is somewhat supported by other participants who also talk about being in “Uni-mode”. P5 reports this as a negative, feeling that the preceptorship year was an extension, and at times a repetition of university and that she felt as if she needed to prove herself all over again. Whereas other people viewed it in a less negative light, they did report how being in student mode meant that they did an amount of work at home that potentially should have been acknowledged as part of their working day. P1, P3, and P4 all reported working on their preceptorship at home and that this was seen as acceptable because they were still in ‘student’ or ‘Uni’ mode.
Figure 4: Preceptorship as part of a journey of development.
The ‘real world’ was considered anxiety provoking in the sense that these were real people and if interventions did not work then it meant that you had got it wrong (P3), however there was also a feeling of growth described by the participants, that they learnt from those around them (P5) and that they had the ability to reflect on their development (P1), as well as the realisation that the: “learning is gonna be forever” (P7).
101 5.5.3 Confidence.
Five of the participants discussed how the feeling of starting work as a newly qualified occupational therapist was quite a daunting experience, which supports this research’s claim that the process of becoming an occupational therapist is one the continues after university. P3 describes feeling: "terrified” when she first started and P5 reports experiencing that first year as being: "overwhelming”. This is also a word that P4 used to describe the time in that first year; she compares becoming a qualified occupational therapist to the time when you have first passed your driving test stating:
“oh my god, somebody has let me see patients and I'm on my own”.
P1 and P6 use the word daunting to describe the preceptorship process itself feeling that the concept of having to sit down and review yourself was: “quite scary” (P6).
During this preceptorship period though, six of the participants referred to how they felt that their confidence had grown. Only one (P5) felt that had nothing to do with the preceptorship process and felt that just doing the job would have made her confidence grow regardless. However, the other participants felt that there were aspects of the preceptorship process that contributed to their individual growth in confidence. P1 and P7 felt that becoming immersed in occupational therapy and gaining knowledge of what could be offered in terms of assessment and intervention and thereby having ownership of the role, meant that their confidence developed during the preceptorship year. P6 felt that setting goals and realising that you had achieved them on reflection, within the process had helped build confidence. She specifically found feedback from the preceptor helpful, she states that:
“They think you are doing better than what you think you are and that builds your confidence”.
P4 felt that the paperwork and the supervision structure within the preceptorship year had helped her to identify areas in which she had confidence, and acknowledge how this had developed, so that even when it came to moving on to her next rotational post she was able to be: “aware that your skills are transferable”.
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It is P1 that relates that her confidence was also associated with a sense of achievement. She acknowledged that her confidence had developed as she became more comfortable with her role, and she then questioned herself less. She reports at the end of the preceptorship process that it had made her:
“Realise how much she had come on . . . and what I had learnt. It felt good after all that work”.
Others also reported a sense of achievement P3 states:
“Wow, I’ve done all this, that’s amazing . . . but you can’t help but grow when you are challenged”.
P4 when asked “when you got to the end of that preceptorship year did it feel like yeah I can do this?” replied with a very definite:
“Yes I did, I very much felt like that”
The journey of preceptorship, therefore, is only one part of a larger journey. A journey that, in its entirety, starts when occupational therapy is chosen as a career and ends when the individual chooses to no longer define themselves as an occupational therapist.
5.5.4 Conclusions and implications of the journey theme.
The journey of development starts at a point in time where the profession of occupational therapy as a whole has a duty to promote itself. That is before people have signed up for education, at the stage of preformed ideas. In this research, four of the seven participants described talking to occupational therapists about their jobs before signing up to become a member of the profession. This implies that it is the responsibility of each individual occupational therapist to promote themselves and the profession whenever possible as it would appear that by individuals endorsing occupational therapy as a career, others have been attracted into the profession.
It is also clear that there are some areas of preceptorship that could be considered as essential to the journey and continued growth of the individual. The participants defined these as being, reflective practice, goal setting, appropriate training, role modelling and
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mentorship, all of which are recognised in the literature as the being benefits of the preceptorship process and preceptorship relationship (Department of Health 2010, Morley 2012). Therefore although the process has some critics within the interview participants it would appear overall that in terms of a journey of development the preceptorship process was viewed as having value.