The need for occupational therapy educational standards reform: Addressing the real problem behind the push for a doctoral mandate

As a profession, occupational therapists have been spending time talking about opposing the motion to mandate the doctorate – but we need to spend time trying to solve the problem that is bringing this issue to the table.

I believe that we have a specific problem (too many credits in masters programs) and some of our colleagues are trying to justify the escalated degree solution by conflating the real problem with a lot of side issues that may not be accurate (e.g. doctorates will give us a seat at the table, doctorates will make us more respected, doctorates will maintain parity with other professions, doctorates will make people practice at the top of their license etc - all evidence-free platitudes).

We should try to address the Credit Problem by reforming curriculum, reforming ACOTE standards, removing excess from those systems - and that will solve the REAL underlying problem.

Here are some ideas that Caroline Alterio and I generated and that she posted on the AOTA forums the other day. Let’s contribute to a REAL solution by encouraging dialogue around the REAL problem:

What can be trimmed from the standards? A lot.

1. Requirements for escalation in Bloom's taxonomy. Every time that we escalate the complexity of Bloom levels we add to the curriculum. Much can be trimmed on a standard by standard basis based on Bloom complexity. We do not need frontline practitioners, our primary outcome objective, being able to analyze and evaluate for societal determinants of health on a public health level as much as we need them to simply demonstrate knowledge of the issue. This is an example of how we over-require complexity in our Bloom levels in the curriculum.

2. We have added population level care into many of our standards, and yet the primary outcome objective is to produce clinicians who treat patients. OTs can understand population level impacts, but we have expanded the curriculum exponentially with turning us into a public health profession - which does not reflect how most OTs practice anyway. It is an imagined role that is not reflected in any practice analysis that has ever been completed.

3. We can constrict content based on other imagined roles that are very uncommon to our primary outcome objective. Case management is a good example - a fine role for someone who does not want to provide direct care OT but hardly something that needs to be in an entry level curriculum. OTs in case management roles are very uncommon, and yet we include it in the curriculum now based on special interests.

4. We can constrict requirements under other categories like management, education, and advocacy. These are all important functions but we continue to escalate the complexity of requirements far beyond what most practicing clinicians will ever need to engage. Do we really need to have instructional/curricular design as a standard? Our primary outcome objective is not to produce occupational therapy educators.

5. The same is true for scholarship and obtaining grants. Our primary outcome objective is clinicians and not researchers. The point here is not to exclude this kind of content from the curriculum but that we need to design the requirements/standards at a level that make sense for intended outcomes - consuming evidence and applying literature - not designing studies and obtaining grants.

6. Do we really need to mandate that all students complete work in emerging areas where there are not OTs, or to even allow them to pursue fieldwork placements or capstones where non-OTs are supervising them. It is so odd that an occupational therapy degree would include training supervised by people in places who are not occupational therapists and where occupational therapy does not happen. A generation of training in non traditional settings has not moved the needle on non traditional practice. All we created is an endless stream of students doing demonstration projects in soup kitchens and then graduating to go work in schools, hospitals, and nursing homes. It is a failed experiment.

We have not spent enough time discussing the existing problem with our educational standards. The few times it has been raised it has led to straw man arguments like 'We can't exclude evidence based practice from the standards.'

Standards reform is a nuanced process and should not result in polemic and polarized arguments that distract us from the important work of evaluating and reforming our current system. No one wants evidence based practice out of the standards. However, that is different than teaching entry level students about obtaining grants and implementing research.

Again, the point is to direct the curriculum toward the primary objective - and that is toward the production of practicing clinicians.  It is not our primary objective to produce educators or toward creating imagined public health roles that don't reflect actual practice.  We need those functions, but advanced content should be just that - advanced. It is over-education for our primary role and purpose and does not belong in an entry level curriculum.

Advocating for a pragmatic curriculum should not devolve into conversations about not being 'visionary.' I think we can be appropriately visionary without requiring all participants in an entry level program to engage in activities that they will never again do once they leave the academic setting, or that will only be engaged in by very small percentages of people who pursue highly specialized roles.

Let's address the REAL problem - and try to come to a REAL solution.


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