6 minute read
Shaping New Graduates Experience: Learning to Make Intervention Decisions
Elizabeth Moir, PhD candidate, The University of Queensland Jodie Copley, Associate Professor, Occupational Therapy, The University of Queensland Merrill Turpin, Senior Lecturer, Occupational Therapy, The University of Queensland
I think this is what I want to do… I’m not sure if this is what I want to do… I’ll check before I do it… (S1 NG11)
… as a new grad, you do get frustrated, because it doesn’t come easy… it takes time to make decisions. (S2 Sen. 3)
These phrases were used by a recent new graduate and experienced occupational therapists working in paediatric practice when describing their experiences of learning to make intervention decisions. It has long been identified that the transition from student to occupational therapy practitioner is stressful1-3, with decision-making identified as one aspect of practice that is challenging for new graduates4-6. Numerous decisions are made daily in occupational therapy practice–when planning for assessment and intervention, but also during and after service provision. Decision-making within paediatric occupational therapy practice may be particularly challenging for new graduates due to the need to simultaneously engage children with varying abilities while also meeting the needs of the whole family.
Previous research has focused on support for new graduates during the transition to practice generally, with little addressing new graduate decision-making. It has also focused on workplace support, rather than new graduates’ personal resources and support from the professional community. To better understand new graduates’ experiences of learning to make intervention decisions when working with children and families, we undertook a research project using case study methodology7. This enabled us to explore new graduates’ experiences within three diverse paediatric service delivery models–private practice, an acute hospital, and nongovernment organisations (NGOs). We sought the perspectives of current new graduates, as well as experienced occupational therapists who had navigated the new graduate years and supported new graduates, who were able to reflect on their experiences.
Findings: Support and Resources
Participants identified a range of common supports and resources that influenced and informed new graduates’ intervention decisions. These included:
• Support from others: formal supervision sessions and informal discussions with colleagues and individuals within new graduates’ personal networks (i.e. university staff and peers, own family) enabled new graduates to ask questions, check their plans and clinical reasoning, gather ideas, and receive validation and reassurance. Opportunities for work shadowing and joint sessions provided a baseline for new graduates to follow, and confirmed their current practice. • Physical resources: these ranged from on-site written materials to university notes and online resources • Knowledge and experience: knowledge and experience gained while at university from coursework and student placements gave new graduates something to fall back on. Knowledge and experience gained within the workplace enabled them to draw on their early workplace clinical experiences and translate intervention ideas between clients. • Feedback and reflective practice: reflective practice enabled new graduates to reflect on the decisions they made and determine whether they needed to change their approach in the future. Seeking feedback from colleagues, clients, and families was often used to affirm their decisions.
Seeing progress in their clients also helped new graduates to know they were making the right decisions. Initially new graduates relied more on their colleagues to help them know what to do, but as they gained practice experience they felt more confident to make their own decisions and mostly only sought support for unfamiliar or complex cases. They also began to make faster decisions by drawing on previous experiences within the workplace. However, despite a range of supports and resources being identified as useful, not
all new graduates were able to access or use all support mechanisms that were available, describing variable experiences.
Findings: Differences Between Settings
A range of contextual factors impacted new graduates’ ability to access and use available supports and resources, and influenced their overall experiences of learning to make decisions. For example:
• Access to support: new graduates working in private practices solely providing paediatric services appeared to have greater access to on-site support and resources compared to those working in practices that serviced both children and adults. Those with less on-site support were sometimes offered external supervision or went without.
Many new graduates in private practices appeared able to draw links between the work they were undertaking and everyday experiences in the wider community, such as ways of managing children’s behaviour. This enabled them to draw on a variety of supports, resources, and experiences external to the workplace, and outside the profession, when making intervention decisions. • Being seen as capable and competent: some new graduates within private practices described wanting to be seen as capable by families, key stakeholders and their employers, and providing a financially worthwhile service. This sometimes led to seeking information from university peers and their own family members and friends when making decisions, rather than ‘bothering’ or appearing incompetent to those with whom they were working. It also appeared to result in a high level of collaboration with families and teachers, a strong focus on engaging children in therapy sessions, and a reluctance to ‘experiment’ with strategies early on in practice. • Time and perceived clinical risk: within the acute hospital setting, the immediacy with which new graduates needed to respond to some referrals made it challenging to access colleagues and resources to support their decisionmaking in the time frame available.
Many new graduates also perceived a level of clinical risk within the work they were undertaking, prompting them to seek support from others when making decisions and a reluctance to learn through ‘trial and error’. The amount of on-site supports and resources reportedly reduced the need for new graduates to seek external support. • Changes in funding: many NGOs are experiencing an increased focus on billable hours following the introduction of the National Disability Insurance
Scheme. As a result, new graduates perceived themselves and their colleagues as ‘time poor’ which impacted their ability to seek support from others and the depth of discussions. The increased demands on occupational therapists associated with the funding changes also impacted new graduates’ ability to engage in reflective practice in the moment.
Findings: Other Influences
Participants described a range of personal factors that shaped their experiences of learning to make intervention decisions. For example, supports and learning opportunities that aligned with new graduates’ preferred learning styles, such as learning through observation, were seen as advantageous. Additionally, new graduates often described having high expectations of themselves when commencing practice, which did not appear to impact their willingness to seek support, but rather impacted how they felt when seeking support or prompted them to speak to individuals with whom they felt a level of comfort. Some new graduates attended professional development events hosted by OTA, but many did not mention drawing upon wider professional bodies to support and inform their decisions.
Implications
While a range of supports and resources have been identified as useful for new graduates in learning to make intervention decisions, personal and environmental factors significantly impact new graduates’ experiences. Therefore, it may be helpful for universities, workplaces, graduates, and the wider profession to further consider:
• Does occupational therapy education need to focus more on occupational therapy students’ personal resources and resilience to prepare them for practice? Or are workplaces responsible for personal skills training? • Are current workplace support mechanisms sufficient for supporting new graduate decision-making? Or are additional structures and tools required to support new graduate decisionmaking and clinical reasoning? • Do workplaces facing time constraints and/or an increased demand for services need to reduce new graduates’ responsibilities (including billable hours) while they are gaining confidence in their decision-making? • How can new graduates’ awareness of the supports and personal resources they bring with them into practice be further supported? • Do professional bodies need to target their supports and resources more explicitly to new graduates’ reasoning and decision-making? About the Authors Elizabeth Moir is approaching the end of her PhD candidature at The University of Queensland. Her research is supported by an Australian Government Research Training Program (RTP) Scholarship, and has been conducted under the supervision of Associate Professor Jodie Copley and Dr Merrill Turpin. Contact: e.moir@uq.net.au
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