- Email: [email protected]
Implementing the Revised WFOT Minimum Standards for the Education of Occupational Therapists
HKJOT STANDARDS 2005;15:3–7 REVIEW ON THE WFOT MINIMUM
INVITED COMMENTARY
IMPLEMENTING THE REVISED WFOT MINIMUM STANDARDS FOR THE EDUCATION OF OCCUPATIONAL THERAPISTS Kit Sinclair President, World Federation of Occupational Therapists
There is a requirement from the World Federation of Occupational Therapists (WFOT) for all schools listed on the approved-schools list to be monitored by their national association every five years. With the revised minimum standards (2002) setup by the WFOT, all national associations are required to review their schools and make sure that they meet the new standards. All schools must meet these standards by 2007 to continue to be listed on the approved-schools list. This article reviews the new standard, which has been revised to incorporate the societal shift toward inclusion, as well as the occupation-based philosophy that is the foundation of occupational therapy. Examples are given in the unique context of Hong Kong. The new standard is less prescriptive than in the past and incorporates local cultural and societal perspectives.
I. Introduction The World Federation of Occupational Therapists (WFOT) was founded in 1952 to promote occupational therapy (OT) worldwide and facilitate its establishment internationally. With one of the major aims of promoting a high-quality profession, the WFOT published the Minimum Standards of Education for Occupational Therapists in 1958, and made the establishment of an educational program a prerequisite for full membership with the WFOT through the national association. In 1998, the WFOT geared up towards revising the Minimum Standards for the Education of Occupational Therapists in order to better meet the changes in OT practice throughout the world, to better reflect the needs and cultures of different countries throughout the world, and to emphasize current perspectives on health and participation. The United Nations and World Health Organization (WHO) documents (UN, 1982;
UNESCO 1995,1998; WHO 1986,1993,1994) provided guidance for an extensive, consultative and collaborative revision process, which culminated in the approval of the Revised Minimum Standards for the Education of Occupational Therapists at the WFOT Council Meeting in Sweden, in 2002. Having one OT school that meets these minimum standards is a pre-requisite for a national OT association to become a full member of the WFOT. The standards address the potential for the use of occupation to build healthy communities, and to enhance wellness by assisting people to develop their personal skills for choosing and performing occupations which support well-being. Occupation is defined as the things people do in every day life that are meaningful in their culture (WFOT, 2002). A number of documents form the basis for the health and welfare perspective on the revision of the Standards. The United Nation documents helped to shift the focus to a vision
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China. Reprint requests and correspondence to: Kit Sinclair, PhD, OTR, FWFOT, FAOTA, President, World Federation of Occupational Therapists, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China. E-mail: [email protected]
Hong Kong Journal of Occupational Therapy ©2005 Elsevier. All rights reserved.
3
HKJOT 2005;15
Kit Sinclair
of health for all people and to a continuous improvement of programmes (UN, 1993, 2002). The WHO’s International Classification of Functioning, Disability and Health (ICF) helped to focus upon activity, participation and the environmental influence on health and occupation (WHO, 2001). The overall structure of the Minimum Standards and the aspects that need to be addressed are shown in Figure 1. These are described in detail in The Minimum Standards of Education for Occupational Therapists (WFOT, 2002).
International perspectives Educational programme
Local context
Graduates
Feedback on graduates
II. Local context
Figure 1. Overview of an occupational therapy programme (figure printed with permission from the World Federation of Occupational Therapists).
Local context refers to five components including students entering the programme; local health and welfare needs; local view of health-giving occupations; local health, legislative, welfare, disability and legal systems; and local occupational therapy history. The emphasis is on local needs in relation to occupation.
and educational resources and facilities. The content and teaching methods need to meet local criteria with occupation as the central core. The programme will address a unique blend of occupational concerns, depending on the predominant local health and welfare needs. The predominant local health and welfare needs may change as society changes.
Local context example: Local health-giving occupations
Curriculum content example: Hong Kong situation
An understanding of local beliefs, values and meaning of occupation will inform occupational therapists how occupation may be used in the local context. These may be using occupation as a tool to enhance well-being or restore health, as a tool for community development, or to describe the goals of OT intervention. Occupation may also be a way of finding out what interrupted a person’s occupational performance, how their environment supports or impedes participation and to influence health and welfare policies and legislation. Knowing local occupation that is a part of people’s everyday lives and how occupation may be a source of health or ill health is essential for an OT education programme.
In Hong Kong in the 80’s there was a huge component in the curriculum on working with patients after industrial accidents, particularly hand injuries from poor machine safety — splinting for hand therapy and pressure therapy was covered in over 30 hours of practical sessions. Now, because manufacturing has moved across the border to Mainland China, the heavy emphasis in Hong Kong on splinting has been toned down and has been replaced by emphasis on teaching content on cumulative hand disorders and repetitive strain injury for ’display screen equipment’ workers — still hand therapy, but with a different emphasis.
IV. Essential knowledge, skills and attitudes for competent practice of graduates III. Philosophy and purpose of the education programme Philosophy and purpose are central to the educational programme and guide all aspects of programme design, development and delivery (ENOTHE, 2002). There are five components of the education programme consistent with the philosophy and purpose of the educational programme that are essential to all programmes. They are the curriculum content and sequence, the educational methods, fieldwork, educators
4
Graduate competencies are what OT graduates are able to do safely and effectively, and are described in relation to five aspects of practice, as shown in figure 2. The new standards require educational programmes to identify the knowledge skills and attitudes that graduates will have in all five areas. These are the person-occupation-environment relationship and its relationship to health; therapeutic and professional relationships; an occupational therapy process; professional reasoning and behaviour; and the context of professional
Hong Kong Journal of Occupational Therapy
REVIEW ON THE WFOT MINIMUM STANDARDS
Students entering the programme
International health, welfare and education perspectives
Local health & welfare needs
Curriculum content & sequence Educational methods
Local view of health giving occupations
Programme philosophy & purpose
Fieldwork
Knowledge, skills & attitudes for competent practice
Educators Educational facilities & resources
Local health, welfare, disability & legal systems
Local occupational therapy history Feedback on graduate performance
Figure 2. Components of an occupational therapy educational programme (figure printed with permission from the World Federation of Occupational Therapists).
practice. All these elements interlink. The actual knowledge skills and attitudes that graduates will have depends on the local health needs that they have been prepared to address (Hocking & Ness, 2002) Each of the areas is described in detail in the revised document (2002), according to the knowledge, skills and attitudes of a WFOT-approved educational program.
Person-Occupation-Environment Relationship (POE) Knowledge, skills and attitudes are described in terms of person, occupational and environment and the relationship of these perspectives with the health perspective.
with the geriatric population is being addressed through study of skills in communication with the elderly, the occupational and leisure and daily living needs of the elderly, as well as the cultural values of the Chinese geriatric population. It addresses the need for safety and environmental modifications to promote participation in their home and community. The subjects offered within these programmes provide a foundation for the development of graduate competencies in relation to the person, environment and occupation of this demographic group.
Therapeutic Relationship Graduate Competencies Example: PEO model In order to meet the needs of changing demographics in Hong Kong, particularly in relation to the aging population, the Bachelor of Science OT(Hons) programme at the Hong Kong Polytechnic University had initially added “Issues for the Aged Population” as an elective subject in the year 2002. “OT Management for Geriatric Practice” is now offered as a core undergraduate subject as well as a post-graduate programme. Essential knowledge, skills and attitudes while working
This area of knowledge, skills and attitudes is about establishing effective working relationships with those who make up the human environment of people receiving OT services.
OT Process The OT process is described in terms of what the occupational therapist does when working with recipients of OT and this will vary with the context and purpose of the intervention.
Professional Reasoning and Evidence-based Practice Five components have been identified relating to meeting local
Hong Kong Journal of Occupational Therapy
5
HKJOT 2005;15
Kit Sinclair
and international expectations of qualified health-care workers. These include Research/Information Search Process, Ethical Practice, Professional Competence, Reflective Practice, and Managing Self, Others, and Service.
Context of Practice Those aspects of the physical, attitudinal and social environments that affect people’s health and participation and also impact upon OT practice are important to the students’ ability to provide practice appropriate for local needs. Both local factors (such as children with disability and access to education) and international factors (such as the Disability Rights Movement) are included (WFOT, 2002).
V. Fieldwork Fieldwork is essential and central to the educational process. Students must be provided with fieldwork experiences that would enable them to experience people of different age groups, who have recently acquired or long-standing health needs, and interventions that focus on the person, occupation and environment. In addition, students must experience working in diverse settings encompassing a selection of personal factors, health conditions, delivery systems, existing and emerging services and individual and group/community/population approaches. A minimum of 1,000 hours of fieldwork is normally expected and students must have the opportunity to practice OT skills. Fieldwork is distributed throughout every year of the curriculum and a learning contract is developed with the student and supervised by a qualified occupational therapist with at least a year’s practice experience.
VI. Details of Standards The details and explanation of the various components of the programme standards for the education of occupational therapists and details of graduate competencies can be found in the document available from the WFOT Secretariat (E-mail: [email protected]). The WFOT Minimum Standards for the Education of Occupational Therapists 2002 (WFOT, 2002) is intended to both set minimum standards and to encourage continual quality development beyond the specified levels. The standards recognizes the dynamic nature of programme design as well as national and regional differences. The standards require that undergraduate programmes at a bachelor’s or diploma level within higher education are run for a minimum of 90 weeks.
6
VII. Monitoring Undertaken by National Associations Monitoring WFOT-approved OT education programmes is the responsibility of the national association. The monitoring process should be undertaken every five years. WFOT expects that national associations: • Have a description of their approval and re-approval processes available. • Include an appeal process in their approval and re-approval processes. • Will appoint experiences educators to be the programme evaluators who will carry out approvals and re-approvals. They may or may not be members of the national association executive group or council, or individuals members of WFOT, but will need access to the WFOT Minimum Standards for the Education of Occupational therapists 2002. A process has been developed by the WFOT, or the national association may establish their own with assistance from the Programme Coordinator for Education and Research, or collaborate with other WFOT members, or work in regional groups to complete approvals. The Programme Coordinator for Education and Research may be contacted for further information about the process.
VIII. Conclusion In conclusion, the revised standards are not prescriptive, are attuned to the cultural and economic needs of all countries, emphasize the outcomes of knowledge, skills and attitudes and focus upon the person-occupation-environment relationship and its relationship to health. By the year 2007, all OT education programmes should adhere to the revised Minimum Standards for the Education of Occupational Therapists document (2002).
References European Network of Occupational Therapy in Higher Education. (2000). Occupational therapy education in Europe: Curriculum guidelines. Amsterdam: ENOTHE. Hocking, C. & Ness, N.E. (2002). Introduction to the revised minimum standards for the education of occupational therapists –2002. WFOT Bulletin 46:30–3. United Nations (UN). (1982). World Programme if Action Concerning Disabled Persons. United Nations UN). (1993). Resolution on Standard Rules of the Equalisation of Opportunities for Persons with Disabilities. United Nations (UN). (2002). Convention on the Rights of the Child. UNESCO. (1995). Policy paper for change and development in higher education.
Hong Kong Journal of Occupational Therapy
REVIEW ON THE WFOT MINIMUM STANDARDS UNESCO. (1998). World Declaration on Higher Education for the TwentyFirst Century: Vision and Action. http://portal.unesco.org/education/ World Federation for Medical Education. (2001). Quality improvement in basic medical education. WFME international guidelines. Denmark: University of Copenhagen. World Federation of Occupational Therapists (WFOT). (1958). Minimum standards for the education of occupational therapists. The Council of the World Federation of Occupational Therapists. World Federation of Occupational Therapists (WFOT). (2002). Revised minimum standards for the education of occupational therapists. The Council of the World Federation of Occupational Therapists.
Hong Kong Journal of Occupational Therapy
World Health Organization, Health and Welfare Canada, Canadian Public Health Association. (1986). Ottawa Charter for Health Promotion. Ottawa: WHO. World Health Organization (WHO). (1993). Increasing the relevance of education for health professionals: Report of a WHO Study Group on problem-solving education for the health professions. Geneva: Author. World Health Organization (WHO). (1994). Declaration on Occupational Health for All. Geneva: Author. World Health Organization (WHO). (2001). International classification of functioning, disability and health. Geneva: Author.
7
INVITED COMMENTARY
IMPLEMENTING THE REVISED WFOT MINIMUM STANDARDS FOR THE EDUCATION OF OCCUPATIONAL THERAPISTS Kit Sinclair President, World Federation of Occupational Therapists
There is a requirement from the World Federation of Occupational Therapists (WFOT) for all schools listed on the approved-schools list to be monitored by their national association every five years. With the revised minimum standards (2002) setup by the WFOT, all national associations are required to review their schools and make sure that they meet the new standards. All schools must meet these standards by 2007 to continue to be listed on the approved-schools list. This article reviews the new standard, which has been revised to incorporate the societal shift toward inclusion, as well as the occupation-based philosophy that is the foundation of occupational therapy. Examples are given in the unique context of Hong Kong. The new standard is less prescriptive than in the past and incorporates local cultural and societal perspectives.
I. Introduction The World Federation of Occupational Therapists (WFOT) was founded in 1952 to promote occupational therapy (OT) worldwide and facilitate its establishment internationally. With one of the major aims of promoting a high-quality profession, the WFOT published the Minimum Standards of Education for Occupational Therapists in 1958, and made the establishment of an educational program a prerequisite for full membership with the WFOT through the national association. In 1998, the WFOT geared up towards revising the Minimum Standards for the Education of Occupational Therapists in order to better meet the changes in OT practice throughout the world, to better reflect the needs and cultures of different countries throughout the world, and to emphasize current perspectives on health and participation. The United Nations and World Health Organization (WHO) documents (UN, 1982;
UNESCO 1995,1998; WHO 1986,1993,1994) provided guidance for an extensive, consultative and collaborative revision process, which culminated in the approval of the Revised Minimum Standards for the Education of Occupational Therapists at the WFOT Council Meeting in Sweden, in 2002. Having one OT school that meets these minimum standards is a pre-requisite for a national OT association to become a full member of the WFOT. The standards address the potential for the use of occupation to build healthy communities, and to enhance wellness by assisting people to develop their personal skills for choosing and performing occupations which support well-being. Occupation is defined as the things people do in every day life that are meaningful in their culture (WFOT, 2002). A number of documents form the basis for the health and welfare perspective on the revision of the Standards. The United Nation documents helped to shift the focus to a vision
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China. Reprint requests and correspondence to: Kit Sinclair, PhD, OTR, FWFOT, FAOTA, President, World Federation of Occupational Therapists, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China. E-mail: [email protected]
Hong Kong Journal of Occupational Therapy ©2005 Elsevier. All rights reserved.
3
HKJOT 2005;15
Kit Sinclair
of health for all people and to a continuous improvement of programmes (UN, 1993, 2002). The WHO’s International Classification of Functioning, Disability and Health (ICF) helped to focus upon activity, participation and the environmental influence on health and occupation (WHO, 2001). The overall structure of the Minimum Standards and the aspects that need to be addressed are shown in Figure 1. These are described in detail in The Minimum Standards of Education for Occupational Therapists (WFOT, 2002).
International perspectives Educational programme
Local context
Graduates
Feedback on graduates
II. Local context
Figure 1. Overview of an occupational therapy programme (figure printed with permission from the World Federation of Occupational Therapists).
Local context refers to five components including students entering the programme; local health and welfare needs; local view of health-giving occupations; local health, legislative, welfare, disability and legal systems; and local occupational therapy history. The emphasis is on local needs in relation to occupation.
and educational resources and facilities. The content and teaching methods need to meet local criteria with occupation as the central core. The programme will address a unique blend of occupational concerns, depending on the predominant local health and welfare needs. The predominant local health and welfare needs may change as society changes.
Local context example: Local health-giving occupations
Curriculum content example: Hong Kong situation
An understanding of local beliefs, values and meaning of occupation will inform occupational therapists how occupation may be used in the local context. These may be using occupation as a tool to enhance well-being or restore health, as a tool for community development, or to describe the goals of OT intervention. Occupation may also be a way of finding out what interrupted a person’s occupational performance, how their environment supports or impedes participation and to influence health and welfare policies and legislation. Knowing local occupation that is a part of people’s everyday lives and how occupation may be a source of health or ill health is essential for an OT education programme.
In Hong Kong in the 80’s there was a huge component in the curriculum on working with patients after industrial accidents, particularly hand injuries from poor machine safety — splinting for hand therapy and pressure therapy was covered in over 30 hours of practical sessions. Now, because manufacturing has moved across the border to Mainland China, the heavy emphasis in Hong Kong on splinting has been toned down and has been replaced by emphasis on teaching content on cumulative hand disorders and repetitive strain injury for ’display screen equipment’ workers — still hand therapy, but with a different emphasis.
IV. Essential knowledge, skills and attitudes for competent practice of graduates III. Philosophy and purpose of the education programme Philosophy and purpose are central to the educational programme and guide all aspects of programme design, development and delivery (ENOTHE, 2002). There are five components of the education programme consistent with the philosophy and purpose of the educational programme that are essential to all programmes. They are the curriculum content and sequence, the educational methods, fieldwork, educators
4
Graduate competencies are what OT graduates are able to do safely and effectively, and are described in relation to five aspects of practice, as shown in figure 2. The new standards require educational programmes to identify the knowledge skills and attitudes that graduates will have in all five areas. These are the person-occupation-environment relationship and its relationship to health; therapeutic and professional relationships; an occupational therapy process; professional reasoning and behaviour; and the context of professional
Hong Kong Journal of Occupational Therapy
REVIEW ON THE WFOT MINIMUM STANDARDS
Students entering the programme
International health, welfare and education perspectives
Local health & welfare needs
Curriculum content & sequence Educational methods
Local view of health giving occupations
Programme philosophy & purpose
Fieldwork
Knowledge, skills & attitudes for competent practice
Educators Educational facilities & resources
Local health, welfare, disability & legal systems
Local occupational therapy history Feedback on graduate performance
Figure 2. Components of an occupational therapy educational programme (figure printed with permission from the World Federation of Occupational Therapists).
practice. All these elements interlink. The actual knowledge skills and attitudes that graduates will have depends on the local health needs that they have been prepared to address (Hocking & Ness, 2002) Each of the areas is described in detail in the revised document (2002), according to the knowledge, skills and attitudes of a WFOT-approved educational program.
Person-Occupation-Environment Relationship (POE) Knowledge, skills and attitudes are described in terms of person, occupational and environment and the relationship of these perspectives with the health perspective.
with the geriatric population is being addressed through study of skills in communication with the elderly, the occupational and leisure and daily living needs of the elderly, as well as the cultural values of the Chinese geriatric population. It addresses the need for safety and environmental modifications to promote participation in their home and community. The subjects offered within these programmes provide a foundation for the development of graduate competencies in relation to the person, environment and occupation of this demographic group.
Therapeutic Relationship Graduate Competencies Example: PEO model In order to meet the needs of changing demographics in Hong Kong, particularly in relation to the aging population, the Bachelor of Science OT(Hons) programme at the Hong Kong Polytechnic University had initially added “Issues for the Aged Population” as an elective subject in the year 2002. “OT Management for Geriatric Practice” is now offered as a core undergraduate subject as well as a post-graduate programme. Essential knowledge, skills and attitudes while working
This area of knowledge, skills and attitudes is about establishing effective working relationships with those who make up the human environment of people receiving OT services.
OT Process The OT process is described in terms of what the occupational therapist does when working with recipients of OT and this will vary with the context and purpose of the intervention.
Professional Reasoning and Evidence-based Practice Five components have been identified relating to meeting local
Hong Kong Journal of Occupational Therapy
5
HKJOT 2005;15
Kit Sinclair
and international expectations of qualified health-care workers. These include Research/Information Search Process, Ethical Practice, Professional Competence, Reflective Practice, and Managing Self, Others, and Service.
Context of Practice Those aspects of the physical, attitudinal and social environments that affect people’s health and participation and also impact upon OT practice are important to the students’ ability to provide practice appropriate for local needs. Both local factors (such as children with disability and access to education) and international factors (such as the Disability Rights Movement) are included (WFOT, 2002).
V. Fieldwork Fieldwork is essential and central to the educational process. Students must be provided with fieldwork experiences that would enable them to experience people of different age groups, who have recently acquired or long-standing health needs, and interventions that focus on the person, occupation and environment. In addition, students must experience working in diverse settings encompassing a selection of personal factors, health conditions, delivery systems, existing and emerging services and individual and group/community/population approaches. A minimum of 1,000 hours of fieldwork is normally expected and students must have the opportunity to practice OT skills. Fieldwork is distributed throughout every year of the curriculum and a learning contract is developed with the student and supervised by a qualified occupational therapist with at least a year’s practice experience.
VI. Details of Standards The details and explanation of the various components of the programme standards for the education of occupational therapists and details of graduate competencies can be found in the document available from the WFOT Secretariat (E-mail: [email protected]). The WFOT Minimum Standards for the Education of Occupational Therapists 2002 (WFOT, 2002) is intended to both set minimum standards and to encourage continual quality development beyond the specified levels. The standards recognizes the dynamic nature of programme design as well as national and regional differences. The standards require that undergraduate programmes at a bachelor’s or diploma level within higher education are run for a minimum of 90 weeks.
6
VII. Monitoring Undertaken by National Associations Monitoring WFOT-approved OT education programmes is the responsibility of the national association. The monitoring process should be undertaken every five years. WFOT expects that national associations: • Have a description of their approval and re-approval processes available. • Include an appeal process in their approval and re-approval processes. • Will appoint experiences educators to be the programme evaluators who will carry out approvals and re-approvals. They may or may not be members of the national association executive group or council, or individuals members of WFOT, but will need access to the WFOT Minimum Standards for the Education of Occupational therapists 2002. A process has been developed by the WFOT, or the national association may establish their own with assistance from the Programme Coordinator for Education and Research, or collaborate with other WFOT members, or work in regional groups to complete approvals. The Programme Coordinator for Education and Research may be contacted for further information about the process.
VIII. Conclusion In conclusion, the revised standards are not prescriptive, are attuned to the cultural and economic needs of all countries, emphasize the outcomes of knowledge, skills and attitudes and focus upon the person-occupation-environment relationship and its relationship to health. By the year 2007, all OT education programmes should adhere to the revised Minimum Standards for the Education of Occupational Therapists document (2002).
References European Network of Occupational Therapy in Higher Education. (2000). Occupational therapy education in Europe: Curriculum guidelines. Amsterdam: ENOTHE. Hocking, C. & Ness, N.E. (2002). Introduction to the revised minimum standards for the education of occupational therapists –2002. WFOT Bulletin 46:30–3. United Nations (UN). (1982). World Programme if Action Concerning Disabled Persons. United Nations UN). (1993). Resolution on Standard Rules of the Equalisation of Opportunities for Persons with Disabilities. United Nations (UN). (2002). Convention on the Rights of the Child. UNESCO. (1995). Policy paper for change and development in higher education.
Hong Kong Journal of Occupational Therapy
REVIEW ON THE WFOT MINIMUM STANDARDS UNESCO. (1998). World Declaration on Higher Education for the TwentyFirst Century: Vision and Action. http://portal.unesco.org/education/ World Federation for Medical Education. (2001). Quality improvement in basic medical education. WFME international guidelines. Denmark: University of Copenhagen. World Federation of Occupational Therapists (WFOT). (1958). Minimum standards for the education of occupational therapists. The Council of the World Federation of Occupational Therapists. World Federation of Occupational Therapists (WFOT). (2002). Revised minimum standards for the education of occupational therapists. The Council of the World Federation of Occupational Therapists.
Hong Kong Journal of Occupational Therapy
World Health Organization, Health and Welfare Canada, Canadian Public Health Association. (1986). Ottawa Charter for Health Promotion. Ottawa: WHO. World Health Organization (WHO). (1993). Increasing the relevance of education for health professionals: Report of a WHO Study Group on problem-solving education for the health professions. Geneva: Author. World Health Organization (WHO). (1994). Declaration on Occupational Health for All. Geneva: Author. World Health Organization (WHO). (2001). International classification of functioning, disability and health. Geneva: Author.
7