Practitioners Perceptions of the Occupational Therapy Clinical Doctorate

Transcription

1 RESEARCH NOTES Practitioners Perceptions of the Occupational Therapy Clinical Doctorate Anne E. Dickerson, PhD, OTR/L, FAOTA Leonard Trujillo, PhD, OTR/L Six hundred occupational therapy practitioners from seven states responded to questions inquiring about the perceptions of the occupational therapy clinical doctorate degree, both at the entry-level and post-professional positions. The majority of respondents does not approve of moving to the doctorate for entry-level practice, and are not interested in pursuing the degree personally. The most common reasons for the low interest are the respondents belief that the degree will not further their careers, that practitioners cannot afford to stop working to pursue another degree, and that they cannot balance work, family, and education. The small number of respondents who are interested in the clinical doctorate degree want it for personal development and are interested in clinical practice specialization. J Allied Health. 2009; 38: e47 e53. IN 2006, WILLIAM SILER and Diane Randolph addressed the question of clinical doctorates in The Chronicle of Higher Education by examining the arguments for and against the raising of the professional degrees to the clinical doctoral level 1. Their conclusion was that neither universities nor professional organizations objectively evaluate clinical doctorates and they suggested that an external study, such as the Flexner Commission, should be done to establish uniform criteria. This paper will discuss the clinical doctorate debate in occupational therapy and will present findings from practitioners perceptions of the occupational clinical doctorate. In 1999, occupational therapy entry-level educational programs were mandated to move to a post-baccalaureate degree, this criterion to be completed by Resolution J was passed by the Representative Assembly of the American Occupational Therapy Association (AOTA) with the stipulation that programs not making the transition would not be eligible for re-accreditation. At the time of the resolution, many programs had already undertaken the process of transitioning to the master s degree level, if only to be competitive Dr. Dickerson is Professor and Dr. Trujillo is Associate Professor and Chair, Department of Occupational Therapy, East Carolina University, Greenville, NC RN807: Received May 7, 2008; accepted August 29, Address correspondence and reprint requests to: Anne E. Dickerson, Professor, Department of Occupational Therapy, East Carolina University, Health Sciences Building, Greenville, NC Tel ; dickersona@ecu.edu. with other occupational therapy programs across the nation already at that level. As well, they were spurred on by programs in physical and speech therapy already at the master s level. While Resolution J identified that the entry level must be at a post-baccalaureate level, it did not mandate a specific degree level as the standard. Thus, various models of post-baccalaureate degree programs have been implemented to meet the needs of different institutions. These include the combined baccalaureate/master s degree where the student completes three years of undergraduate work, is accepted into the master s degree program, and then completes two years of graduate degree work. There are variations among schools as to whether the student is granted a baccalaureate degree and/or the master s degree. Other programs have developed what has been termed as the Master s of Occupational Therapy Degree, where the student applies as a graduate student and completes the degree, typically in a two-and-a-half year time frame. A further expansion has been the development of the occupational therapy clinical doctorate. Now that (as of 2008) all occupational therapy programs are at the post-baccalaureate level, the debate has moved to the next rung. Now under discussion is the clinical doctorate, including its purpose, quality, deliverance, and --the most contentious -- whether it should be the entry degree for practice. Given that other allied health fields such as physical therapy, pharmacy, and audiology programs have moved to doctoral entry-level, educational leaders in occupational therapy are engaged in ongoing debates about the occupational therapy doctorate (OTD) and its role in the profession and higher education. As far back as 1994, Runyon, Aitken, and Stohs argued that the growing shortage of doctorally trained faculty could be resolved with the development of OTD programs 2. However, since the OTD is not seen as equal or parallel to the research doctorate 3-4, graduates of OTD programs may have more difficulty securing tenure track positions in universities with high research demands. In addition to the controversy of whether the OTD can meet the faculty vacancy issue, there are other arguments against clinical doctoral programs. Siler and Randolph contend that clinical doctorates represent degree creep, may exacerbate the shortage of health care workers, increase health-care disparities in our society, and decrease the amount of research needed for evidence-based medicine 1. In 1999, Pierce and Peyton made a strong case for development of the OTD with a historical review of professional Journal of Allied Health, Spring 2009, Volume 38, Number 1 e-47

2 TABLE 1. Participants surveyed by State (randomly selected) State No. of No. of % Surveys % therapists Surveys Returned licensed Sent Texas 5, Nebraska North Carolina 1, Oregon Wisconsin 2, Alabama Pennsylvania 4, Unknown 29 Total 17, clinical doctorates in pharmacy, nursing, and physical therapy 5. Their reflection supports the appropriateness of the OTD, arguing it creates a clinical scholar who can autonomously operate as a change agent in health care systems and sensitively interpret the human condition presented by patients (p.70) 5. Others also advocate for the degree using strong arguments for the OTD being the degree of entry 6-8. Thus, it appears there is a place for the OTD within the occupational therapy profession. The Accreditation Council for Occupational Therapy Education (ACOTE) adopted Accreditation Standards for a Doctoral-degree-level Educational Program for the occupational therapist effective January 1, The process of the development of the occupational therapy doctorate standards followed the protocol of open hearings, written correspondence, and invitation for comments. However, this approval process did not occur without its debates and formidable arguments at conferences and educational meetings. These debates included arguing for and against entry-level doctorates and what should constitute the standards for entry-level doctoral programs. Although the process sought to be open and collaborative to the various groups of stakeholders, it can still be argued that many occupational therapist practitioners might have been unaware of the process. The discussion took place among those in academic environments and at professional meetings and may have failed to include those practitioners at the grassroots level. Practitioners who were not members of the national organization and attended only local continuing education meetings might have been uninformed about the discussion and debate involving the clinical doctorate. Thus, the purpose of this study is to explore the perceptions of practicing occupational therapy practitioners: those who are not necessarily associated with the professional organization or associated with any particular educational program; in essence, the grass roots practitioners. Specific questions included the perceived differences between entry-level and post-professional clinical doctoral degrees, why a practitioner would be or would not be interested in pursuing a occupational therapy doctoral degree, what areas of specialization would be attractive, and how the practitioner felt about requiring a doctoral degree as the entry-level degree to practice. The survey clarified that entry-level doctoral programs allow students to enter having no other professional degree, while post-professional doctorate degrees are for those with professional practice degrees already (e.g., OTR) and who return to achieve a higher degree, specifically a clinical doctorate. SAMPLE Methods To examine the perceptions of a clinical doctorate, this study used a national, random survey method. The aim of the study was to survey grass roots practitioners who were not necessarily members of their professional organizations. It was decided to select one state from each region of the country: the northwest, northeast, southeast, midwest, west, and southwest. Since licensure boards have a list of all of the occupational therapy practitioners in a state, the boards of seven selected states were contacted to get random lists of names. In some cases, the states originally selected had to be changed because the license board refused access (e.g., New York). Once there was representation for each area of the United States, the selected boards sent the researchers the mailing labels or electronic lists of practitioners. The exception was in North Carolina, since the names were already accessible through a published booklet sent to all licensed occupational therapists. Using the lists, a random sample of practitioners was selected from each of the seven states. Surveys were mailed over a period of three months. In the first two states, Nebraska and North Carolina, 25% of the licensees were selected: in Nebraska because of the low number of licensees, and in North Carolina because there was more interest in viewing the home state. Due to mailing costs, only 10% of the licensees were surveyed in the other four states and because of the high access fee for each name, only 5% of the licensees in Wisconsin were surveyed. This study was approved by East Carolina University s Institutional Review Board. INSTRUMENT The survey instrument was constructed by the authors and reviewed by several occupational therapist educators for clarity and appropriateness of content. Based on their feedback, changes were made to enhance the final survey used. The survey consisted of four main sections. All participants were e-48 DICKERSON AND TRUJILLO, Practitioners Perceptions of the Occupational Therapy Clinical Doctorate

3 Table 2: All Respondents: Mean and Standard Deviation for Questions Comparing entry-level and post professional OTD with paired t-test results. Question n Mean SD t df p 2-tailed A post-professional OTD prepares therapists for the demands of working as a clinician An entry level OTD prepares therapists for the demands of working as a clinician A post-professional OTD prepares therapists for supervision and management An entry-level OTD prepares therapists for supervision and management Having a post-professional OTD increases the credibility of occupational therapists when working with other health care professionals Having an entry-level OTD increases the credibility of occupational therapists when working with other health care professionals A post-professional OTD will likely be current in new or innovative evaluations and treatment interventions An entry-level OTD practitioner will likely be current in new or innovative evaluations and treatment interventions A post-professional OTD practitioner will likely be current in evidence-based practice An entry-level OTD practitioner will likely be current in evidence-based practice Scale: 1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5= strongly agree asked to respond to the first and last sections. The second and third sections were based on the participant s interest in completing an OTD degree. The primary format was a 5-point Likert-like response scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, and 5=strongly agree). There was room provided for comments under each question, if the respondent chose to respond. The last section was the demographic data on all respondents. Respondents were sent the survey, a cover letter, and a postage-paid, self-addressed envelope. Returned surveys were numbered to easily identify the states of the respondents. No follow-up mailings were done due to cost restrictions. The surveys were opened and entered into a spreadsheet using an identified code number. Results The total number of respondents was 600, with a mean age of 40 years (Standard Deviation=9.71). Ninety-three percent were female (n=560) and 7% were male (n=40), reflective of the gender ratio in the profession. Fifty-nine percent (n=343) of the respondents had an undergraduate degree in occupational therapy as their highest degree, 32% (n=184) had a master s degree, 2% (n=14) an OTD, and 6% (n=36) another type of doctoral degree. Eight respondents (1%) were currently pursuing a higher degree. Table 1 lists the number of licensed occupational therapists surveyed from the seven states, the percent randomly selected to receive a survey (2 states at 25%, 4 states at 10%, 1 state at 5%), the number of surveys sent (range from 93 respondents in Alabama to 532 respondents in Texas), the number returned (range from 11 returns from Alabama to 161 returns from North Carolina), and the return rate from each state (range from 12% to 40%). Thirty respondents did not identify the state of their licensure. The total number of licensed therapists for the seven states was 17,509. 2,002 surveys were sent for a 12% random representation of the practitioners in the seven states. Out of the 2,002 surveys sent, 600 were returned for an overall return rate of 30%. Table 2 compares all of the respondents perceptions of the knowledge and skills acquired in post-professional and entrylevel degrees by illustrating the means, standard deviations and a paired t-test. There is no significant difference between respondents views of the two degrees in regard to preparing the therapist for the demands of working as a clinician. However, there are significant differences in the other areas examined with the mean higher for the post-professional clinical doctorate. When asked if an entry-level occupational therapy clinical doctorate and an entry-level occupational therapy master s degree should have similar requirements for entry-level standards of education, 346 of the respondents (58%) agreed or strongly agreed, 115 (12%) were neutral, and 271 (23%) disagreed or strongly disagreed (see Table 3). When asked if an entry-level occupational therapy clinical doctorate and a post-professional occupational therapy clinical doctorate should have similar requirements once the entry level standards were met for the entry-level clinical doctorate, 305 (51%) agreed or strongly agreed, 112 (19%) were neutral, and 178 (30%) disagree or strongly disagreed. Finally, when asked Journal of Allied Health, Spring 2009, Volume 38, Number 1 e-49

4 TABLE 3. Number of respondents and mean for questions about OTD degrees. Questions n Mean SD If an OTD degree was necessary to keep my job, I would leave profession I would pursue an OTD degree if my workplace provided tuition compensation An entry-level OTD and a post-professional OTD should have similar requirements once the entry-level standards of education are met for the entry-level OTD students An entry-level OTD and a post-professional OTD program produce such different type of graduates that they should not be considered the same degree A post-professional master s degree in occupational therapy will assist a practitioner to specialize An entry-level OTD and an entry-level master s degree should have similar requirements for the entry-level standards of education =strongly disagree, 2=disagree, 3=neutral, 4=agree, 5= strongly agree TABLE 4. Number and percent of respondents answering the question about increasing to the entry-level doctoral degree by age groups Total Frequency Total Percent 29 or younger years years Over 50 years n % n % n % n % Strongly Disagree Disagree Neutral Agree Strongly Agree TABLE 5. Respondents reasons for being interested in OTD, mean, standard deviation, and extend of agreement with top seven reasons. Question N Mean Standard Strongly Strongly Neutral Neutral Agree/ Agree Deviation Disagree/ Disagree Number Percent Strongly Percent Disagree Percent Agree Number Number Value personal development and learning Increase OT skills and knowledge Want to teach part time Want to advance career & OTD is option Clinical research Advance career in non-traditional areas To teach full time Scale: 1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5= strongly agree about the statement that an entry-level occupational therapy clinical doctorate and a post-professional occupational therapy clinical doctorate produce such different types of graduates that they should not be considered the same degree, 300 (51%) agreed or strongly agreed, 160 (27%) were neutral, and 136 (23%) disagree or strongly disagreed. When asked if they would leave the profession if an occupational therapy clinical doctorate was necessary to practice, 50% (n=298) strongly agreed or agreed, 20% (n=117) were neutral, and 30% (n=176) disagreed or strongly disagreed. When respondents were asked whether they would pursue a clinical doctorate if the workplace provided tuition compensation, 42% (n=249) agreed or strongly agreed, 27% (n=163) were neutral, and 31% (n=184) disagree or strongly disagreed. When asked whether the post-professional clinical doctorate would help a practitioner specialize, 65% (n=386) agree or strongly agreed, 19% (n=113) were neutral, and 16% (n=98) disagreed or strongly disagreed. All respondents were asked: As of 2007, the entry-level degree for occupational therapy is at the post-baccalaureate degree level (master s or doctoral level). What is your opinion about increasing it to the doctoral level? Over 65% disagreed with increasing the entry- level practice degree to doctoral level (see Table 4). When grouped by age, chi square analysis indicated that there was a significant difference (c2(12, N=575)=46.37, p=.001), with older therapists indicating they did not want to increase to the entry-level doctorate. There were no significant differences between respondents from different states or between males and females (c2(24, N=598)=24.67, p=.42). RESPONDENTS INTERESTED IN THE CLINICAL DOCTORATE One hundred fifteen of the respondents (19%) indicated that they would be interested in an occupational therapy clinical doctorate. Their mean age was 35.9 years (SD=9.1); 33 (28%) were 29 or younger, 45 (39%) were years old, 24 (21%) were years of age, and 14 (12%) were over 50 years old. The areas of practice with highest representation e-50 DICKERSON AND TRUJILLO, Practitioners Perceptions of the Occupational Therapy Clinical Doctorate

5 TABLE 6. Number and percent of those interested and very interested in particular areas of emphasis in curriculum. Question N Mean Standard Interested Interested Deviation Frequency Percent Personal Practice Area % Assessment Emphasis % Supervision & Leadership % Service Delivery Area % Education % Technology % Administration & Management % Research % Scale: 1=not interested at all to 5=very interested. TABLE 7. Practitioners s degree of agreement with reasons for not being interested in pursuing an OTD. Question N Mean Standard Strongly Disagree/ Neutral Neutral Agree/ Agree Deviation Disagree/ Strongly Number Percent Strongly Percent Disagree Disagree Agree Number Percent Number No Reward to get a degree Financial difficult No Time due to Family obligations No time due to work obligations No Interest in returning to school I would pursue another Degree I would not meet the standards were physical disabilities (57%) and pediatrics (37%). The highest percent interested were practitioners with 4-9 years of practice (37%); 24% of those interested had less than 3 years of practice, 22% had years, and 17% had 20 or more years. Respondents were offered a list of reasons for possible interest in pursuing a clinical doctorate and asked to indicate the extent of their agreement with the reason. With the agree/strongly agree and disagree/strongly disagree responses combined, valuing personal development and learning as well as increasing occupational therapy skills and knowledge had the highest levels of agreement (see Table 5). Of special note, personal practice area (94%) was the area of emphasis in the curriculum in which respondents were most interested. Assessment, supervision and leadership, education, and service delivery area fell to less than 75% (see Table 6). Only 37 respondents (32%) rated research as an interest area in the OTD curriculum. RESPONDENTS NOT INTERESTED IN THE CLINICAL DOCTORATE Eighty percent of the respondents, or 480, indicated that they were not interested in pursuing an occupational therapy clinical doctorate. The mean age of these respondents was 40.6 years (SD=9.7); 7% were male and 93% female. Twenty-two percent (n=103) were over 50 years of age, 29% (139) were years old, 35% (168) were years old, and 14% (69) were 29 years or younger. Eighty-five percent of the respondents agreed or strongly agreed that a reason for not pursuing an OTD was no reward to get degree. Other reasons with over 65% agreement include financial difficulty and no time due to family obligations (see Table7). Discussion The majority of these clinical practitioners did not approve of moving to the doctoral level for entry-level practice. Only 13% agreed or strongly agreed while 17% were neutral, and an overwhelming 68% disagreed or strongly disagreed. As may be expected, the data shows the older, undergraduatetrained practitioner as more likely to disagree that the occupational therapy clinical doctorate degree should be the entry-level degree. The implication is that practitioners at the grassroots level believe that the profession should remain at the master s degree level. Respondents believe clinical doctorate graduates may be more current in evidence-based practice or have innovative treatment and evaluations options, but lag behind in day-today work demands of the full-time clinician. There are several similar written comments such as There is no substitute for work experience, regardless of educational level under the related questions. The scope of this study does not include comparing master s degree with undergraduate degree graduates. Thus, it is impossible to determine if the perception of the clinical doctorate degree is that it does not prepare one for practice or that, as several respondents indicated in additional comments, only working in the real world can prepare one for practice. To the respondents, the fieldwork/clinical component is seen as essential to attaining competency as a therapist. The majority of respondents think that entry-level master s degree and entry-level clinical doctorate should have similar Journal of Allied Health, Spring 2009, Volume 38, Number 1 e-51

6 requirements for education. Of note is the perception that while the clinical doctorate graduate may have an initial cutting edge advantage upon assimilation into the clinic, after about three years that advantage is lost. The study s results suggested that practitioners perceive those with a post-professional clinical doctorate to be more able to meet the demands of management, to have more credibility, and to be more current in evaluation, treatment and evidence-based practice. Given that practitioners value experience, one would expect them to view the post-professional graduate to have both experience in the field and additional education. When asked if entry-level and post-professional clinical doctorate degrees should have similar requirements once entry-level standards are met, 51% agreed/strongly agreed and 30% disagree/strongly disagreed. Yet when asked if the two degrees should not be considered the same degree, 51% agreed/strongly agreed and 23% disagreed/strongly disagreed. These responses certainly appear conflicting in nature and might be indicative of the confusion that remains in the field in regard to acceptance of the occupational therapy clinical doctorate. This is in contrast to other professions, who do not distinguish between entry-level and post-professional doctorates The data here supports the notion that practitioners do distinguish between the two types of degrees. A finding that was disquieting is the lack of desire to pursue higher education. This corresponds to previous research 12, which also indicates that less than 20% of the respondents are interested in pursuing graduate degrees. Given the number of clinical doctorate programs developing, the competition for this small number of interested candidates could be significant. Another area of concern was the fact that research and administration/ management are the areas of least interest. Usually, clinical doctorate programs are not designed to emphasize research, and administration/management skills can be obtained with other post-professional degrees (e.g., public administration, business). However, the need for research is also acute, and, as Siler and Randolph argued, the development of clinical doctorates threatens research1. Given the results of this study, occupational programs might consider other markets for students rather than just as working practitioners. Based on the results from this survey, programs should target young practitioners, emphasize personal development, and emphasize the practice areas of physical disabilities and pediatrics. A small number of practitioners may want the doctoral degree to teach part-time, advance their career, or participate in research. These respondents indicated that the significant reasons for not pursuing the clinical doctorate are lack of monetary reward and/or advancement for pursuing a higher degree. A majority also indicated that it would be financially difficult to pursue a degree due to loss of income and the cost of higher education. Finally, a majority said they have no extra time due to family obligations and work obligations. In a femaledominated field, it is not surprising that family obligations is one of the top reasons cited for lack of interest in pursuing higher education. Forty-seven percent (47%) of the respondents indicated they would pursue a higher degree in other fields, rather than occupational therapy. These fields included business (MBA), education, public health, physician assistant, physical therapy, law, and specialty areas such as gerontology, pediatrics, management, etc. One may draw from this that the working clinician already has the primary set of clinical skills necessary to do the job they are doing, and that if they take the time to add to their knowledge, practitioners want a new skill, not just to enhance their current ability. Of note, few respondents indicated interest in pursuit of a PhD, ScD or other research degrees in occupational therapy. LIMITATIONS A limitation of the study was the survey instrument. Content validity was limited to face validity. Another limitation of this study was the lower than expected response rate. Two states had very low rates (Alabama and Texas), lowering the overall rate of return. One factor of the low response rate might have been that there were no reminder follow-ups mailed to the respondents due to budget restrictions. Other contributing factors are speculative, but recall these are individuals who may not to be members of the national association and thus may be less concerned with responding to surveys or activities requiring an active response on their part. However, considering the representation of the respondents, and the fact that there is limited information on the issue being examined, we believe the results of this survey add to the knowledge about the perception of occupational therapy clinical doctorates and are reflective of currently practicing clinical therapists. The information gained offers some verification of what educators and leaders in the profession may suspect about practitioners perceptions of the OTD. Additional research would be helpful, and given the responses gathered, an interactive process might prove more beneficial than another survey process. In fact, the suggestion made by Siler and Randolph to establish an external study of clinical doctorates would hopefully incorporate all methods of assessment 1. SUMMARY In summary, 600 practitioners from 7 states responded to questions inquiring about their perceptions of the clinical doctorate, both entry-level and post-professional. The majority of respondents did not agree with moving the entry-level degree to the doctorate level and were not interested in pursuing the degree personally. The most common reasons for low interest included the opinions that the doctoral degree would not further careers, practitioners could not afford to stop working to pursue another degree, and/or could not balance work, family, and education. A small number who were interested in the degree wanted it for personal development e-52 DICKERSON AND TRUJILLO, Practitioners Perceptions of the Occupational Therapy Clinical Doctorate

7 and were most interested in clinical practice specialization. The ramifications of the perceptions indicate that it would be important to show evidence of positive results from the move to doctoral level in other fields and a focused education on the need for higher education requirements. REFERENCES 1. Siler WL Randolph DS. A clinical look at clinical doctorates. The Chronicle Review. 2006;53(46);B Runyon CP Aitken MJ Stohs SJ Commentary: The need for a clinical doctorate in occupational therapy. JAH;1994:23(2); Higher Learning Commission, for North Central Association of Colleges and Schools. Task force on the professional doctorate: Meeting and recommendations working draft. 2005, October Coppard BM Dickerson AE. A descriptive review of occupational therapy education. AJOT. 61(6); Pierce D Peyton C. A historical cross-disciplinary perspective on the pro fessional doctorate in occupational therapy. AJOT. 1999;53(1): Royeen CB Stohs SJ Should the clinical doctorate degree be the standard of entry into the practice of occupational therapy? Innovations in Occupational Therapy Education. 1999; Mu K Coppard B Padilla R. Graduate outcomes of first entry-level occupational therapy doctoral program in the United States. Education SISQ, 2006;16(1): Krutis S. Consider doctoral education. OT Practice Oct 11(7): Accreditation Standards for a Doctoral-Degree-Level Educational Program for the Occupational Therapist. American Occupational Therapy Association. Retrieved April 6, 2008 from: aota.org/educate/accredit/standardsreview.aspx. 10. Rogers JC Design of the master s degree in occupational therapy. Part 1: A logical approach. AJOT. 1980:34; Rogers JC. Design of the master s degree in occupational therapy. Part 2: An empirical approach. AJOT. 1980:34; Dickerson AE, Wittman, MP Perceptions of occupational therapist regarding post-professional education. AJOT. 1999;53(5): Journal of Allied Health, Spring 2009, Volume 38, Number 1 e-53