Therapy Students in the Clinic: A Realistic Look

As students are finishing up their final rotations of graduate school and preparing to take their national board exams (AKA a scary, intimidating test that determines if they can actually do what they went to school for…), I thought it would be a good moment to talk about what it means to have a therapy student in your facility.

If you are a therapist, that means you’ve been a student. There’s no getting around it. As a student in an OT master’s degree program, you must complete Level II Fieldwork in order to graduate, which typically consists of two 12-week placements during which you practice hands-on clinical applications of everything you learned in school.

But what exactly does that look like?

For a student:

-You are super enthusiastic, excited to make a difference, and you haven’t been jaded by the real world just yet. Enjoy it. I’m serious. Enjoy the opportunity to practice your skills as you are on the verge of completing something you have worked very hard for.

-This is your chance to decide if a certain field is where you want to practice. So if you get a pediatric rotation, I sincerely hope you have an interest in pediatrics. The information is specific, nuanced, and difficult to do half way. So please, don’t tell your Fieldwork Educator, “I’m never going to work in pediatrics,” before the rotation even starts. It’s a real bummer for us.

-It can get boring in the beginning as you meet an overwhelming caseload and do more observing than interacting, but for the love of all that’s decent in the world, DO NOT FALL ASLEEP! Take notes, practice your skills of observation, and get acquainted with parents and families. On the flip side, as you get in the groove of treatment, expect to be exhausted. You’re constantly thinking on your toes, planning, moving equipment around, and it’s tiring.

-Please ask for help. I’ve had quite a few students give off an air of confidence that was borderline annoying. I’d be blown off by a quick nod or shrug while trying to explain a concept, which made me assume they knew what I was talking about. So when I let them “sink or swim,” I finally got an admission that they were just nervous to look like they didn’t know something. It’s kind of the whole point to be learning new things.

-It’s fair to ask for a concrete set of expectations. How many patients should you expect to see each week? At what point are you expected to take on a full caseload, if at all? Having a clear set of expectations allows you to be better prepared for what’s coming. I mean, I was forced to lead a small group session on my first day of a rotation. (Don’t worry, I only blacked out a little bit from the fear.)

-Supervision: You want it? You don’t want it? According to the AOTA practice advisory for Level II students, the initial level of supervision is line of sight, but that can decrease depending on a number of factors. I know I was treating people alone on numerous occasions when I was a student. This can be a delicate balance depending on the setting, and I hope you aren’t being treated as a means to increase staff productivity; you are there to learn. Ultimately, your supervising OTR or COTA is responsible for the services you provide.

-This is essentially a 12 week job interview. Don’t take the opportunity lightly, because as the field becomes more saturated, those connections you make can be all the difference. So be on time, do what is asked, and even if you know you don’t want to do the job, you never know how your fieldwork experience might impact what’s ahead in your career.

For a Child/Parent/Patient: 

-Have an open mind. A student comes in with a lot of textbook knowledge, but the execution might be super awkward as they begin. However, I can guarantee that student has likely put a ton of time and thought into the activities they are attempting with your child, and I have discussed and/or approved these ideas.

-Adjusting the children to a new person can be difficult, and then preparing them for their departure can be even more of a challenge. It is a strange concept to invite a new person into a close-knit therapeutic relationship for a limited amount of time, but we have to all work together to make it as seamless as possible. And no, I’m not quitting or training my replacement, as like 75% of parents assume when I introduce a student.

-So you are private paying $150 a session to work with a student? Yes, you totally have the right to tell me you don’t want a student working with your child. I will try my best to explain the process and how much supervision and planning goes into their training, but sometimes a parent is adamant that they just don’t want anyone else working with their child. Please speak up if you are uncomfortable, it’s a learning experience for everyone.

-Ultimately, I’m going to want the student to run an entire session on their own. This doesn’t mean I’m being lazy, or want to take a break (ok, maybe a little…), it means they have gained the confidence and the skills to plan and implement a therapeutic session from start to finish. I might just be watching, making comments or notes, or busying myself with something else so that I can actually let them try and work things out on their own.

For a Therapist/Fieldwork Educator:

-Ah yes, the opportunity to impart wisdom, experience, and life lessons along to the next generation of colleagues. Sure. But ALSO, doing your regular job while simultaneously explaining every aspect of said job to an affixed shadow in the hopes they can absorb, synthesize, and execute it in a skilled way.

I feel like there are two reactions to this particular challenge:
1) Therapists who revel in the opportunity to show their skill set. Some of these therapists are able to foster an amazing learning environment, while some just make the students cry in the bathroom at least once a week.
2) Therapists who reluctantly take on a student because they know they should, and try their best to find time in their schedule to teach as much as they can, crossing their fingers that they get a “good one.”

-There is a payout for that investment of time and energy up front, because as the student becomes more competent and confident, they are able to assist you in a big way. Plus, to have an additional set of hands is a beauty and a luxury one must not take lightly. (Bathroom breaks for everyone!)

-You might have to check your ego a bit. I’ll admit, this is hard to do. There have been times when I’ve noticed I get a bit protective of my treatment plans and have to open up to a student’s new ideas. And if something new works, you have to let go of the “why didn’t I think of that?” guilt.

-Free continuing education! Ok, so just a skimpy 0.5 hours of CE for every week you have a student. Which again, it’s free, but it’s definitely way more work than going to a conference and possibly much less inspiring. Yes, you might gain some new insight or fresh technique ideas from a student, but it’s not going to be all you need.

-Through the student’s university, you typically gain access to journals, academic connections, and all that other good stuff that will turn you into a super-therapist (and I swear I’ll look at it all when I find that spare time…).

-You have to mesh with a new person all up in your space. Even when most of them seem so young. (Does this date me? I think it dates me.) But if I get another email from a student that starts “Hey!” rather than a real greeting, I might just cry. Plus, you must be prepared to adapt to someone’s learning style, therapeutic style, and ability (or lack thereof) to demonstrate clinical reasoning and flexibility when that treatment plan they worked so hard on gets thrown out the window.

-Most importantly, as much work as it is for the therapist, it is an opportunity to give back to your field. Without facilities willing to take on students, or therapists willing to be Fieldwork Educators, we wouldn’t have new therapists. So while it can be a lot of work, it can be very rewarding as well. Think of it as an opportunity to be introspective about your caseload, have a fresh set of eyes, and keep your interventions current and evidence based.

So to all the new OTs out there about to graduate, congrats and good luck!

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About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Occupational Therapy, Therapy Process and tagged , , , , , . Bookmark the permalink.

4 Responses to Therapy Students in the Clinic: A Realistic Look

  1. 00dreams00 says:

    I’m an OT in England, working in Learning Disability. I have had a variety of students, ranging from those who don’t even intend to practice OT let alone have an interest in Learning Disability, through those who are good but not inspired (or inspiring, to those who are a joy to watch and nurture as they discover what it’s all about and find their enthusiasm. Students in this bit of England don’t get much of a choice about where they go on placement, so we can’t do much about their preconceptions; we can only try to impart our passion to the best of our ability and hope that the underlying value of OT for everyone is left with the student as they go forward.

    • Wow, I know I’ve worked at many places that won’t even entertain the idea of a student unless they pass an interview and prove they have an interest in working in the field of pediatrics. I commend your commitment to sharing your passion!!

  2. Kacey says:

    This was fun to read as a student who just graduated and is currently studying for the Big Bad Exam (eep!). Practitioners like you (I’ve been reading your posts for years now, so helpful) are who inspire me to be a clinical educator myself one day! (But maybe after I get a TON more experience of course!)

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