Community Care

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Innovative Learning

In an academic setting—mentoring

By Liz Mullan and Lynn Cockburn

Most educational programs for occupational therapists (OTs) have both classroom-based courses and a range of exciting field-based practicums. But the “Building Practice through Mentorship” course—part of the MScOT Program in the Department of Occupational Science and Occupational Therapy at the University of Toronto—is different. It is not what you would think of as typical university course: there is no lecturer standing at the front of a large group of students, no PowerPoint presentations and no exam at the end. Rather, students learn through active engagement with an experienced and respected OT mentor in small-group discussions.

Today’s graduates need innovative thinking, problem solving and critical appraisal abilities to become competent OTs. They require excellent interpersonal skills and the capacity to reflect on their own practice, so that they can be agents for change with their clients and patients, and in the systems they work in. Known as professional or “soft” skills, these competencies are as important as the clinical and technical skills that OTs need for success.

With that in mind, our University of Toronto OT program now uses many types of learning models and activities. By being proactive with respect to social changes and focusing on advocacy in professional practice, this course is just one example of the ways in which we foster innovative thinking as part of everyday practice.

What does the course look like?
The course uses a range of learning activities, including small-group discussions, reflective papers and building a professional portfolio. Over the two-year program, students work in groups of about eight students, with one OT mentor from the community. This small-group milieu allows the mentor to get to know the students very well, while the students develop a more personal relationship with a practicing OT than they would with a classroom lecturer.

The mentor groups allow students to question, explore, discuss, debate and transform their understanding of becoming a professional. They talk about professional dilemmas and questions that have arisen in other courses and during their placements. Topics include how to give and receive feedback, the process of developing reflective practices and understanding fieldwork experiences through a professional lens.

A key part of the course is writing reflective papers to help to monitor professional and interprofessional growth. These reflective papers are geared to the question: “How did [a specific learning experience] help me to better understand myself in terms of preparedness, knowledge, abilities, fears, biases, attitudes, strengths or skills?”

Papers cover a wide range of topics. To name a few: Communication Styles within the Team, Client-Centred Approaches and Ethical Dilemmas. Both the reflection papers and the group discussions are structured to help students reflect on their thoughts and feelings about how issues of diversity (e.g., race, ethnicity, sexual orientation, socioeconomic status) are addressed in practice. Because these discussions are personal, they also help each student identify areas for personal and professional development.

Who are the mentors, and what do they do?
Each year, well-respected and experienced OTs from the community are nominated to be mentors. The course coordinators talk with the nominated OTs to ensure that they will be a good fit for the course, and that they can make the two-year commitment. Students are randomly assigned to groups. Around 25 meetings are held as part of the course—about every two weeks during the times that students are taking other courses at the university. The role of the mentor is to guide, coach and facilitate students to be reflective, self directed and insightful as they integrate, analyse and synthesize the multiple aspects of learning to be a practicing OT.

Mentors are encouraged to share their professional learnings and to tell “stories” that connect with the students’ experiences. It is the mentor’s role to create a safe and confidential environment that fosters exploration and encourages the students to take risks in talking about their thoughts during other courses and their actions during fieldwork. As the students progress in the curriculum, they are expected to be more active in driving the content of the group sessions and in facilitating meetings. To promote a collegial—rather than competitive—environment, the course and required assignments are marked on a pass/fail basis.

Let us hear from two graduates
In preparation for this article, the authors approached two recent graduates to reflect on their experiences from the mentoring program. They responded enthusiastically! Here is a snapshot of their feedback.

From Batoul Ahmad, class of 2015
“My mentorship group gave me confidence. And through facilitating my own sessions, I began to develop my identity as a professional…I learnt that there are unique components to a professional graduate experience, such as reflection, fostering enhanced group dynamics, facilitation, and giving and receiving positive and constructive feedback. I didn’t experience these elements of professional development in my undergraduate studies…The group was a space in which we could share our challenges and celebrate our successes along the way.”

From David Guo, class of 2015
“Having a background in the sciences, I was not used to this type of discussion and was initially uncomfortable with it. As I progressed through the program, however, I found comfort in my ability to reflect. Having had this experience in reflective practice made reflecting on my current practice as a therapist a much easier process. After each placement we discussed our experiences, including our strengths, weaknesses and things to work on for the next placement, and wrote about these in our reflective papers. Most importantly, we had the opportunity to discuss our struggles during our placements.”

Class of 2017—a work in progress
The class of 2017 (entering in September 2015) recently completed their first semester—a daunting one for most of them. Heavy coursework with high expectations, many tests, new classmates, adjusting to a big and often unfamiliar city and university, and having to adapt to new approaches to learning are just some of the challenges they have had to face.

At one point in the semester, a group of students were reflecting collectively with their mentor. They grappled with the realization that some students have tightly held assumptions. As one example: Upon returning from her first clinical placement, one student talked about how she was amazed that a hospital would discharge a 90-year-old woman home alone to her downtown Toronto apartment. The student’s willingness to share her surprise opened up some broad-ranging conversations about patient-centred care, the right to autonomy, independence and empowerment, and the values that we might hold about “old people.”

As this group began its second term and the students reflected back on their first months together, two major themes became evident. The first related to the small-group format. At the beginning of the course, most students were unfamiliar with small-group learning—a method of learning used throughout the program—and struggled to work collaboratively within groups of eight
or nine to produce the desired results.

rccm_occupational2The second major theme related to presenting and the anxiety it generated in several students. In order to increase their comfort level, students committed to using the mentoring meetings as a safe place to speak up and take responsibility to direct the content. Group members have committed to giving and receiving feedback about their presentation performances—key skills for OTs as interprofessional team members and competent practising therapists. As you can see from the picture on the previous page, these students are very excited about their journey to become top-notch OTs.

A core experience
The mentor groups have been a core part of the University of Toronto OT program for many years now. While some of the details have changed, the fundamental experience has not—working with a mentor and a small group of peers, students learn about the power of collegial, reflective and challenging discussion to develop innovative practice.

We extend our thanks to the current and past co-instructors:
Anne Fourt, Sylvia Langlois, Barry Trentham and Susan Farrow, and to Melissa Paniccia, the current teaching assistant, all of whom have contributed to developing the course structure. Thanks also to Batoul Sayad Ahmed and David Guo, and Mentor Group 5, for their contributions to this article. 

Liz Mullan, BSc OT, Reg (Ont) Adjunct Lecturer, and Lynn Cockburn, PhD, MEd, MSPH, OT Reg (Ont), Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto.

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