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When Theory Does Not Crosswalk

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NBCOT recently released a crosswalk analysis comparing the OTR examination content outline with the ACOTE educational standards . Most of the document tells us what we would expect: the entry-level practice tasks described in the certification exam outline are broadly represented in the ACOTE didactic standards. That is useful, and it is reassuring, but it is not the most interesting part of the document. The more interesting part is Table B, which identifies the ACOTE standards that are not reflected in the NBCOT examination task statements. Some of those differences make immediate sense. Professional history, philosophy, the distinct nature of occupation, policy, advocacy, and systems-level thinking are not always going to map cleanly onto a certification exam content outline. Certification exams are task-oriented by design. Educational standards should be broader than test preparation because occupational therapy education is not simply about preparing people to pass an examination...
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Occupational Therapy’s Real AI Problem, Part II: When a Chatbot Can’t See the Profession’s Own Ethical History

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  I recently wrote that occupational therapy’s real AI problem is not ChatGPT itself, but us. More specifically, it is our profession’s vulnerability to confident, polished, automated explanations built on partial knowledge, private frameworks, and unexamined assumptions. I argued that the real risk is not that a machine will invent nonsense from nowhere, but that it will absorb and amplify the profession’s existing epistemic weaknesses. Now we have Part II of this discussion. I was reminded of this topic when I posed a straightforward question to AOTA’s new chatbot . I asked it "Has there ever been any tension around how to operationalize the ethical principle of social justice in occupational therapy, and what would a violation of that look like in practice?" The answer I received was plausible, polished, but very superficially informed - and thus, fully incorrect. It discussed system barriers, inequities in access, conflicting values, organizational constraints, and the ...
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The Quiet Redefinition of Occupational Therapy

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Before the profession gets too deep into updating the Occupational Therapy Practice Framework, I think we should take some time to pause and reflect on both the substance and process of the revision. While preparing a lecture recently, I found myself revisiting a section from my occupational therapy theory textbook where I trace the successive definitions of occupational therapy that have appeared in the various editions of the Practice Framework. I included that section in the book because the pattern bothered me when I first noticed it, and it still does. When the definitions are placed side by side, something becomes clear that is easy to miss when each revision appears on its own. Since the first Occupational Therapy Practice Framework was published in 2002, the profession has repeatedly revised its official definition of occupational therapy through successive editions of that document. None of the changes are dramatic in isolation. But taken together they represent a gradual and ...
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Input Is Not Fixed: What Alternative Game Controllers Can Teach Occupational Therapy

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I recently came across a project from students at Rochester Institute of Technology that got me thinking. At the Game Developers Conference, RIT students showcased a collection of alternative game controllers that were definitely not standard - they were i nterfaces built from oversized scissors, giant toothbrushes, physical wiring stations, and other unconventional objects. The assignment challenged students to design interactive systems that deliberately moved beyond traditional controllers like keyboards, mice, and gamepads. At first glance, these projects are playful and experimental and I think that is part of the point. The exercise seems designed to disrupt assumptions about how humans interact with digital systems. But the deeper idea embedded in the project is more interesting and is something I would like our future occupational therapy students to deeply integrate into their thinking: Input is not fixed. Once you step outside the standard paradigm of buttons and joysticks, y...
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The Future of OT Education: A Candid Look at What Comes Next

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At the recent ALC meeting of the AOTA, there was a question about why we are seeing a drop in student interest in OT programs. There seemed to be a hesitancy to look internally and critically at the real reasons so I decided to do my best to answer that question. Label me as a reluctant futurist. +++++ Occupational therapy stands at a pivotal moment. For years, we’ve operated with an assumption that the future of the profession should be bigger, more academic, more credentialed, and more “doctorate-forward.” For a while, that vision aligned with workforce need and cultural momentum. But lately, the data tell a more complicated story and I believe that many of us in education and professional governance have been unwilling to confront directly. Here is the uncomfortable truth: The rapid proliferation of OT programs, especially entry-level doctorates, is no longer being driven by workforce demand, public need, or educational innovation. It’s being driven by institutional survival, tuit...
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Occupational Therapy's Real AI Problem Isn't ChatGPT - It's Us.

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Something unfortunate has been happening in occupational therapy, and I’ve been watching it develop for years. At first it was a little distant but now it is uncomfortably close. The profession has always had its share of plucky innovators and small-scale entrepreneurs, but the landscape has shifted. An increasing number of young therapists are building a “personal brand,” launching a subscription service, or producing downloadable content with a logo and a tagline. These are not just side hustles - for some, it is the work. None of this is inherently bad - and I understand why it happens. Salary-to-debt ratios look like a punchline and clinical autonomy is chipped away by policy and productivity expectations. It makes perfect sense that people look elsewhere to find meaning, income, or both at the same time. But something gets distorted when the gravitational pull of monetization starts to reshape what counts as knowledge in the field. The distortion becomes even more concerning wh...
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Teaching Occupational Therapy Ethics Through Speculative Fiction

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Like many others navigating the skies this week, I ran headlong into the perfect storm of weather delays, FAA flow restrictions, and cascading cancellations. By Wednesday it became clear I wasn’t getting to the AOTA Education Summit - at least not physically. I made the error of having too short a window for connecting flights... Rather than let the workshop vanish into the ether, I decided to take a different path and record the full presentation from home. In some ways this feels appropriate, because the talk itself is all about imagination, accessibility, and democratizing ethical inquiry . If people couldn’t gather in one room, then why not open the room to everyone? The presentation -  “Teaching Occupational Therapy Ethics Through Speculative Fiction” - explores how narrative forms can help students engage with complex moral problems in ways that feel emotionally safe and intellectually honest. Ethics education today often unfolds in a climate where students worry more abo...
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