In the U.S. standards of practice, AOTA Code of Ethics and NBCOT Code of Conduct do not address behavioral standards or expectations or standards of field supervisors or professors towards students, or of clinical supervisors towards supervisees. We have been told that codes of conduct and ethics and state boards of health all exist to protect the public. State and nationally mandated minimum requirements for continuing education credits are intended to ensure ongoing competence in patient care. Boards that investigate complaints and enforce codes of ethics are a safeguard that patients receive the best possible care.
But do they? And what does that mean? A public health board is largely reactionary in nature, responding to complaints of possible violations to ethics. The point of occupational therapy is the people we serve. It makes sense that there are safeguards in place to protect them from harm. But as I will argue in the essay, protecting patients from harm (and indeed, providing them with the best possible care) begins long before an ethics complaint is lodged against a therapy professional. It begins with demanding the highest standards of excellence from students in training to become tomorrow's occupational therapy assistants and therapists, but even more importantly, from today's professors, fieldwork educators and clinical supervisors.
AOTA provides specialized training for fieldwork educators, but it is costly, time-consuming, and not mandatory. The greatest learning opportunities for budding occupational therapists are not in the lab or the classroom, but in the field, in actual practice. Unfortunately, because of a shortage of necessary fieldwork educators, almost anyone that can meet the minimum standard--a license and one year in practice--is sought out for these positions, regardless of their qualifications, quality, or lack thereof.
It is an all-too-common story: a student gets stuck with a recalcitrant, incompetent, or even hostile fieldwork educator who has taken on a student to ease their own work load and pick up continuing education credit. It is so common that it is practically a rite of passage. In my own experience as a student, I dealt with fieldwork educators who were exploitative, unethical, and downright abusive.
As with other professions, great emphasis is placed on the expectations and responsibilities of the fieldwork student, and rightly so. It is only through rigor and demonstration of competence and professionalism that anyone can or should hold the title of occupational therapist. However, while other professions also have standards that hold their fieldwork educators accountable as well as their students, occupational therapy has none. What ethical guidelines do fieldwork educators subscribe to that safeguard students from abuse and exploitation from a therapist or employer in a position of power? Sadly, there are none. It is also telling that our own code of ethics has no provisions what so ever that address the rights or explicate the roles and responsibilities of teachers, professors, administrators or fieldwork educators in relation to students, or state what the consequences should be for a breach of decorum or a failure to uphold one's duties.
When I was directing an occupational therapy department, one of my duties is to oversee a fieldwork program. I addressed this problem by creating a code of ethics that specifically delineated the responsibilities of fieldwork educators to the students they supervised. It addressed conduct as well as competence. Borrowing from the occupational therapy professional Code of Ethics, the principles of beneficence and nonmaleficence are especially germane to the conduct and competence of fieldwork educators, and they should be tailored to ensure that expectations are clear.
Fieldwork educators are responsible for the most important and fragile period of a student therapists' professional development. Whatever the individual motives are for the prospective fieldwork educator, preparing future generations for the work we do is a sacred trust. Having a current license and one's year's practice experience is a low bar that our profession sets for this heavy responsibility. It sends the message that virtually anyone in practice is qualified to be a fieldwork educator and corollary to that, experiential learning is of little value. However, as many former students can sadly attest, even decades of experience is not, in and of itself, an adequate measure of competence in a teacher--either one using more traditional didactic pedagogy or one utilizing phenomenological methodologies.
A fieldwork educator must be more than merely a repository of information or even simply highly skilled at their professional niche within the field of occupational therapy. They must have excellent communication skills, patience, tenacity, compassion, empathy, and above all be a role model and mentor who demonstrates therapeutic use of self to their student, with patients and clients and with their colleagues. In short, they must be able to teach effectively. They must also "walk the talk." Educators who uphold their legal and employer mandated minimum standards for job performance, but hypocritically conduct themselves in an unprofessional manner, breed cynicism, apathy and low morale at the pivotal moment when students require--and deserve--inspiration, trust, and respect. I find it fascinating that without any valid clinical necessity or justification, our profession has made the decision to mandate a doctorate for entry-level practice for new therapists. But while lip service is paid (and academia is paid, handsomely) for this exterior window-dressing, little attention is given to formulating meaningful standards and qualifications for the most important aspect of a therapist's training.
What value will a clinical doctorate hold, if we emphasize theory over practice? If we choose to deify classroom learning and while we ignore or leave to chance, the quality of students' experiential education? Fieldwork is where students cease being students, and become real therapists.
The lack of even minimal rigor in standards for competence and ethics in our fieldwork educators is one that imperils the future of of our profession. My next post will include a Code of Ethics for Fieldwork Educators that I put into practice while I was directing an occupational therapy department. If AOTA and other organizations were to adopt and adapt this code of ethics and formulate standards of practice for fieldwork educators and clinical supervisors (one that includes both their expected competencies and leadership responsibilities towards students and supervisees), our profession would have of foundation of high standards and clear expectations that would be taken far more seriously by other professions than merely requiring entry-level practitioners to hold doctorates.
More than simply taking these steps to be taken seriously by other professions, we must do them for our students, who are the future of our profession. Every investment we make in better preparing students, in demonstrating high standards of clinical skill, modeling compassion, therapeutic use of self and other professional behaviors, will be felt by their future patients and clients at some point as well as their colleagues from other disciplines. By demanding intellectual rigor of our clinical supervisors and fieldwork educators, by insisting that they comport themselves with the highest degree of professional integrity and demonstrate knowledge and skills at a level better than the average therapist, we in effect send the message to students that "this is who you should aspire to be and this is who you can be."
Sadly, while many people might take these points for granted as obvious, there is a real need to explicate, codify and strictly enforce them. Unfortunately, much of academia IS ruled by the culture of status, seniority, abusive interactions due to the power differential between teachers and students. This culture takes slightly different forms but is even more insidious in the capitalist environment of the workplace where clinical supervisors hold power over individual therapists. While the first and foremost need for a fieldwork educator and clinical supervisor code of ethics is to demand intellectual rigor from our leaders and to improve the quality of our teaching, leadership and ultimately patient care, it also is needed to protect the rights of students and workers who have little to no recourse when they are trapped in an abusive situation with a professional superior.
We must return to the idealism and multitude of possibilities with which our profession began. We must abandon the intellectually lazy and ethically bereft message that rank and seniority rule, that students and therapy professionals should simply pay homage to whomever has highest seniority in the classroom or office. The best leaders know that leaders are developed and nurtured, not born and that leadership has nothing to do with power and status, but merely the ability to connect with and inspire people. In this milieu, all ideas have parity until their utility is proven otherwise and the good teacher recognizes that even they have something to learn from their students. But regardless of who holds the role of teacher and who holds that of student, all interactions are civil, respectful and proceed on the basis of mutual cooperation and respect.
I will close by stating that a Code of Ethics for Fieldwork Educators will not solve all of the problems outlined above, but it is a start. It is a way to signal a beginning to changes we can make to the cult and culture of academia that benefit mutual respect, openness, democratization of ideas and promote high standards. My next post will be the actual Code of Ethics for Field Work Educators I used while I ran the fieldwork education program when I directed an occupational therapy department.