Accreditation Council for Occupational Therapy Education

So often, gratitude is an afterthought: a thank you as you walk out of a room, a note card, a bouquet of flowers, even a hug. However, when you begin in gratitude and try to live in gratitude, you are ever mindful of all that abounds in your life. My state of gratitude is grounded in the company of sojourners from many walks of life, all of whom offer a continuing source of love, support, and encouragement, often to the point of overflow. This lecture is dedi- cated to all of you.

Education as engine is short and alliterative and creates a great image for an entity that connotes power: power to transmit, power to transport, and power to transform. Education as engine is predicated on an overarching concep- tual framework in three parts. Part 1: Education as Product invites you to see education as a commodity that directly benefits society, one that will transmit down through each generation. Education as Product serves society; it is not personal. Part 2: Learning as Process invites you to see learning as different from education and not confuse the two. Learning as Process is personal and directly benefits us as individuals such that we may transport our ideas in fluid and flexible ways. Part 3: Living as Progress invites you to see yourself as a “living-ologist” (my term), looking at lives as they are enacted over time and intervening at key points to transform that which has been disrupted. Living as Progress is a societal and personal journey and the linchpin of our profession. These three constructs have potential to evoke change only if you are willing to think about them conceptually, to think more abstractly than you usually do.

As with theories, concepts are not bound by place and time, nor can they have conditions attached to them. It is their very abstractness that gives you the freedom to apply them anyplace, anytime (Reynolds, 1971). This Slagle Lecture is not about generating a thousand solutions you can implement tomorrow. It’s about doing more reflective thinking before engaging in making change. Consequently, I’m the catalyst to spur your thinking, and you are the change agent, not me. Your unique professional context and role is what will generate a take-home message. I do not have a one-size-fits-all message. However, if it helps you, think about a context-specific education change you would like to make and how you might approach such a change using one or more of the three constructs: Educa- tion as Product, Learning as Process, or Living as Progress.

Part 1: Education as Product

If education is the engine that is going to power desired changes for society, its people, and our profession, we need to take a careful look at it and ascertain what it is and what it is not. That’s why I use the phrase Education as Product and recommend for now that you see education as a separate construct from learning. I consider Education as

2014 Eleanor Clarke Slagle Lecture

Education as Engine Maralynne D. Mitcham, PhD, OTR/L, FAOTA


Originally published in 2014 in American Journal of Occupational Therapy, 68, 636–648. http://dx.doi.org/10.5014/ajot.2014.686001

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2014 Eleanor Clarke Slagle Lecture

Product because of the language we use to refer to it when talking or writing. Typically we have a sense that education is a construct to be imparted or acquired, given and received—a nice tidy package. Even the third edition of the Amer- ican Occupational Therapy Association’s (AOTA’s; 2014) Occupational Therapy Practice Framework: Domain and Process defines education as an intervention that involves “imparting [italics added] of knowledge and information” (p. S30). “I received a great education at Bournemouth School for Girls,” I would say if you asked me about my high school experience. Or, in a moment of frustration, you might say, “We need to provide more education to parents so they understand the importance of children completing their therapy routines every night.”

Education as Product comes in a variety of guises. At its broadest, education is for all of society, a large com- modity. When we hold education up as a commodity, we get a better look at what sorts of raw materials make up the product. We can examine each piece of raw material and its relationship to all the other pieces. For example, if the product is a commodity such as food, we can read the list of ingredients on the outside of the box; likewise, if the commodity is a small appliance, we can examine the list of parts. When the product is education, we can list what goes into the commodity to ensure it serves broad purposes and can be assessed as a societal benefit, such that only raw materials serving the common good and promising success go into the product or into the commodity box. This way offers a sense of vetting and gating of collective values, otherwise the box would soon overflow with raw materials favored by a plethora of special interest groups. Whether we are looking at education in general, where it has most effect at the macro or societal level, or reviewing units of product in our own field at the micro level, such as professional board certification programs, much care is required for examination under all these conditions. Small in dimension does not mean insignificant.

At the macro level, throughout the centuries and civilizations, people have wanted their children to grow up in a society that encourages them to become good citizens (Kershaw, 2006), to be resourceful in their livelihoods, and to be mindful that their actions contribute to their health and well-being. We want education to be objective, develop mind and character, build relevant knowledge and skills, promote understanding and reasoning, and ensure good decision making so that we are always equipping the next generation to attain requisite knowledge and skills to do what will matter most to them in their lifetimes and beyond (Fischman, DiBara, & Gardner, 2006). These are the types of raw materials that go into the product. These raw materials may or may not be your personal choices or mine, but they are those that we hold dear on behalf of society. When there are shifts in society that cause once dearly loved values to change, Education as Product has to realign, hopefully not in knee-jerk fashion, but change it must, even when change comes barreling down at top speed.

The product we need today must serve the 21st century and ensure preparation for that which is to come, some known and still much unknown, much that will need to be thought through carefully before significant change comes to pass. I do not think anyone is ready to give up the three R s in general education. Rather, members of soci- ety seem ready to centralize these skills against a more global back-drop, one that promotes ease of connectivity through the old high-tech–high-touch approach, the interface of technology and people, and keeps opportunity in the forefront and available for all (Partnership for 21st Century Skills, 2008). I believe this to be true for occupational therapy Education as Product.

Hard and Soft Skills

No matter the educational product, graduates must acquire more than new knowledge, which, of course, never ends. For continued success, graduates need to develop hard cognitive and pragmatic skills. Hard cognitive skills allow grad- uates to search for new information as it unfolds. But gleaning more information is not sufficient; they must create distinct criteria to assess the relevance of retrieved information and develop judgment skills to consume only that information needed for their argument or to solve a particular problem. Graduates need to develop hard pragmatic skills by adopting a wide range of technologies, and who better than our current generation of learners, so they can operate from a variety of mobile devices, personal computers, software programs, and the Internet. These hard prag- matic skills provide them with the ability to operate in any digital context (21st Century Skills Foundation, 2013).

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Engagement with hard-core information cannot be the only channel for interacting with society. Graduates need soft skills to manage and align their ability to communicate, collaborate, think critically, connect synchro- nously and asynchronously, create solutions, and change the status quo. They need social and emotional intelli- gence (Goleman, 1995, 2006), especially in a profession called occupational therapy, in which people, environments, and what they do come together in a carefully orchestrated pattern.

Recently, I came across work by an international research group based in Melbourne, Victoria, Australia, com- mitted to helping school-age students acquire the knowledge and skills needed for 21st-century success (Assessment for Teaching 21st Century Skills; Griffin, McGaw, & Care, 2012). The group proposed four major categories of skills that speak to our occupational therapy intentions: ways of thinking, ways of working, tools for working, and skills for living in the world. These skills offer a constellation of existing concepts that we can use anyplace, anytime, and consider as a set of raw materials for the education commodity box.

However, product without purpose is lost, and this elegant quote from Arthur Foshay (1991), a professor of edu- cation, author, and avant garde thinker of his time, sums it up well. “The one continuing purpose of education, since ancient times, has been to bring people to as full a realization as possible of what it is to be a human being” (p. 277)— and, of course, I would add from my occupational perspective, what it is to be a human doing.

Humans Being and Doing

We embrace humans as occupational beings engaging their time and energy in doing things that are meaning- ful, pleasurable, productive, and hopefully healthful; exploring and mastering environments to promote their par- ticipation and becoming creative when obstacles require circumvention. In consonance with all professions, we exist to serve society. In our case, as described in the Framework, we serve through our domain of concern: “achieving health, well-being, and participation in life through engagement in occupation” (AOTA, 2014, p. S2) and, as part of our Centennial Vision proclaims, by “meeting society’s occupational needs” (AOTA, 2007a, p. 613).

Raw Materials

For occupational therapy as a profession to prepare new generations of practitioners, it has to create Education as Product such that practitioners successfully navigate changing, diverse, and complex service delivery in health, education, and community systems. The outcomes of our interventions must be appreciable, noticeable, and reim- bursable. Looking inside the commodity box of entry-level education, you’ll see a potpourri of raw materials. These are our collective professional values and beliefs—or at least those values and beliefs we are willing to stand behind as a collective. We see a variety of professional documents emanating from AOTA reflecting our collective values, most of which we review every 5 years, for example, the Framework, Centennial Vision, Philosophy of Occupational Therapy Education (AOTA, 2007b), Blueprint for Entry-Level Education (AOTA, 2010), Specialized Knowledge and Skills of Occupational Therapy Educators of the Future (AOTA, 2009), minimum educational standards (Accredita- tion Council for Occupational Therapy Education, 2012), and requirements for entry-level certification (National Board for Certification in Occupational Therapy [NBCOT], 2014).

Although we share these common documents, our individual educational programs look highly varied in their design and curriculum content as we strive to meet specific aims that reflect the nature of the institutions in which they are housed: urban, rural, medically underserved, single or multiple sites. Ongoing attention to 21st-century skills is important, and we can appreciate and enjoy these differences because validation of programs is the same for all and reflected through our national accreditation process. Likewise, attainment of initial national certification for entry into the field is the same for all. The NBCOT is the independent regulatory arm of the profession. Like all mature professions, we prefer to regulate ourselves than to be regulated by others. The commodity, occupational therapy entry-level Education as Product, is then replete with commonalities and variations offering prospective applicants choice and at the same time assurance that we deliver on our promise.

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2014 Eleanor Clarke Slagle Lecture

Gert Biesta’s Aims of Education

Gert Biesta (2009), a Dutch, modern-day educational philosopher, has influenced some of my thinking about Edu- cation as Product. Biesta commented that too much learning language has seeped into education and somewhat knocked education aims off course. I think you’ll like his phrase about there being too much “learnification of edu- cation” (p. 36), which is why he recommended elevating the debate and discussion by conceptualizing education and learning as separate products (Figure 65.1). Biesta went on to propose three actual functions performed by edu- cational systems, and these functions create product with some interesting-sounding terminology: qualification, socialization, and subjectification.

Qualification is the most explicit term, because it refers to requisite preparation for a particular group of partici- pants or, in our case, a health profession. Socialization is more implicit, because it focuses on how those new to the profession develop into members in good standing. Subjectification is a little more unusual in that it focuses on how qualified and socialized members may ultimately differentiate themselves one from the other while maintaining their common professional alliance.

Translating Biesta’s (2009) functions into occupational therapy vernacular, we want to ensure that our gradu- ates are indeed well qualified; that they have the requisite knowledge, understanding, skills, and proficiency to enter the field. Moreover, we want to make sure that our graduates are well socialized to our professional values and expected behaviors. Finally, we want to allow for those who have demonstrated subjectivities in the sense that they have gone further in a more independent and autonomous way and generated innovation for the profession. They are still part of the overall professional order, yet their contributions have shown individuation.

My attraction to Biesta’s (2009) classification (qualification, socialization, and subjectification) is that it offers an impartial framework for debating occupational therapy Education as Product, before major reform or significant changes are proposed. A review of raw materials suitable for inclusion requires commitment to collective professional values, especially the ones for entry-level education. So what may seem like a simple change may wreak havoc if we do not account for all the materials and the way in which they relate to each other.

As a way of elevating discussion and looking at our Education as Product squarely in the eye, perhaps we need to open our occupational therapy education commodities box more frequently, lay out what we have, see how the raw materials fit into Biesta’s (2009) three functions of education, and identify where and how we may be falling short and whether sufficient attention has been paid to inclusion of 21st-century skills. Before we consider integra- tion of new knowledge, we have to consider what to jettison. We cling to informing rather than reforming or even transforming. We don’t know how to save ourselves from the incessant urge to add one more topic to an already burgeoning curriculum and fieldwork program. We want students to know everything we know—and they feel pres- sure to know everything, too—rather than equip them with strong collaborative problem solving and reasoning skills such that they know how to retrieve specific information when needed.

Education Learning

Product Process

Societal benefit Individual benefit

Collective values Uniquely personal

Objective Subjective

Purpose driven Meaning driven

Specific aims General intentions

Figure 65.1. Education vs. learning Note. Based on Biesta (2009).

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In a Lancet Commission Report that examined health professions curricula from a global perspective, Frenk et al. (2010) astutely noted that in the past century many of our curricula have progressed from being informative in approach (transmitting information and skills to yield experts) to fostering formative learning (encouraging social- ization and values required of professionals) and, fi to becoming more transformative in nature (promoting leader- ship attributes needed to produce change agents in the next generation of practitioners). The goal of transformative curricula is to generate competency outcomes related to the practice milieu rather than focus on previous student learning outcomes.

Whether we are interested in establishing new degree baselines, modifying existing educational programs, or considering developing new ones, occupational therapy Education as Product must have clear purpose, specific aims, and well-determined outcomes about what we know, who we serve, what we do, and who we are. Figure 65.2 is an adaptation of earlier work in which I demonstrated strategies for ways to connect our theory to our practice. In this instance, the figure shows that Education as Product sits at the very nexus, where all our reasoning processes come together as influenced by our preferences, skills, strengths, and values (Mitcham, 2003).

I trust my phrase Education as Product has offered a new slant to your current thinking, opened up a new win- dow or two for exploration upon return to your particular occupational therapy context and role, provided the pro- fessional association with some options for framing future discussions, and energized us all to

• Do more deductive thinking about occupational therapy Education as Product at the macro or societal level. Consider the whole commodity box before the raw materials, and keep the thinking impersonal

• Do more debating about the raw materials, using readily available existing criteria to help us debate, especially about entry-level education

• Do more discussing about how the ultimately agreed-on product (1) honors what has gone before, (2) reflects on what’s to come, and (3) effectively transmits to succeeding generations.

Figure 65.2. Centering occupational therapy Education as Product to reflect many aspects of the profession and ourselves. From “Integrating Theory and Practice: Using Theory Creatively to Enhance Professional Practice,” by M. D. Mitcham, 2003, in Becoming an Advanced Healthcare Practitioner (p. 81), by G. Brown, S. A. Esdaile, & S. E. Ryan (Eds.), Edinburgh: Butterworth Heinemann. Copyright © 2003 by Elsevier Science Limited. Adapted with permission.

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2014 Eleanor Clarke Slagle Lecture

Part 2: Learning as Process

Learning as Process invites you to see learning as different from education and not confuse the two. Having made the case for education and learning as separate constructs, let’s look at some differences between the two. Learning as Process is undertaken by individuals in search of something new: new knowledge, new skills, or new perspectives. The desire for learning is uniquely personal and therefore subjective, not required to conform to collective societal values. We imbue that which we seek to learn with meaning; meaning for us and our lives, whether we are provid- ing occupational therapy services or are in receipt of them.

Our general intention for learning is transformation (Mezirow, 1978, 2000). We want learning to change us and what we can do. Knowingly or not, we seek out learning when something in our life shifts, for better or for worse. As I see it, learning in occupational therapy includes

• Learning something new: Students select a career path and come into our occupational therapy educational programs.

• Learning something advanced: Practitioners choose to expand upon what they already know; for example, they may pursue an advanced degree, continuing education, or specialty and board certification.

• Learning something completely different: Practitioners choose to retool their career and go in a completely differ- ent direction. For example, they feel they can serve the older adult population more effectively by becoming a lawyer who practices elder law, or perhaps they want to enter the policymaking or population health arena. The recipients of occupational therapy services typically seek new learning when they

• Perceive what they learn will have a positive or preventive outcome for their health condition; • Realize that they may have to learn anew that which has been lost or never tried; and • Relearn new ways to complete familiar tasks of everyday life.

Learning is based on our personality characteristics, our capacities and abilities, our learning styles, and our preferences for how we like to learn: on our own, with another, in a small group or team, with or without tech- nology. Moreover, we know that there are marked differences among generational groups of adult learners that pro- vide challenges for learner and facilitator and for which a fixed, predetermined approach is not going to work; thus, we want to ensure that a fluid relationship develops between learner and instructor because it is unlikely that both will come from the same generational cohort. We know facilitating learning for children (pedagogy) is very differ- ent from facilitating learning for adults (andragogy) and very different from facilitating learning for older adults (gerogogy).

Didactics Versus Mathetics

In much the same way as education and learning are counterparts, so, too, is the science associated with teaching and learning: didactics and mathetics. I’m sure you are familiar with the term didactics, but mathetics? First, a note about the history of didactics: John Amos Comenius (1592–1670) was a scholar from Moravia, considered by some as the father of modern education. His major treatise was the Didactica Magna (Comenius, 1657). A learned man, Comenius wrote his texts in the native languages of the countries then composing Europe instead of writing in Latin—heretofore unheard of—and, if that was not enough, he introduced pictures into his texts. His science of teaching, his didactics, required that instruction move developmentally from simple to complex and be universal and practical in scope and accessible. No one was to be excluded, and he made it possible for women and children living in poverty to benefit from learning. Comenius felt every theory had to be functional and of practical use so that it was morally instructive or didactic. Given the characteristics of his learners at the time, I suspect this approach worked well. The lecture, a common didactic, lives on today. Although lecture has its place, especially for economy of scale, research from the past 50 years has shown that not much improvement has been made in lecturing as a desirable teaching strategy (Mazur, 2009, as cited in Slavich & Zimbardo, 2012).

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Mathetics, a term coined by Comenius, is the science of learning, in contrast to didactics, the science of teach- ing. With mathetics, the emphasis rests on the learners rather than the teacher, and some might be so bold as to say that if the teacher got out of the way, then the learners would fare much better. Constructivist learning theo- rists such as John Dewey, Lev Vygotsky, Jean Piaget, Jerome Bruner, David Ausubel, Jean Lave, and Etienne Wenger would argue that individuals learn best through making sense and meaning of their experiences over time. These theorists suggested that learning is best constructed in a variety of contexts, that each context will have something new to offer the learner, and that the most authentic contexts will offer the most meaningful learning. For learn- ers to construct new knowledge, they have to actively participate and engage with the challenges presented (Ultanir, 2012).

When you consider your current context, you too may find that a constructivist approach is useful for facilitat- ing learning in others. If so, you’ll find yourself orchestrating active, learner-centered, collaborative, experiential, and problem-based opportunities for your learners. Given the desire to learn well and pleasurably ourselves and to be of value to those whose learning we hope to facilitate, we need to give thought to selecting pedagogies that pro- mote effective learning. My own pedagogical repertoire has varied greatly over the decades—in fact, with a new emphasis in each decade. What has driven success throughout these endeavors is not any magic or cookbook for- mula but concepts-based decision making. Every time the context changed, so, too, did the concepts upon which I made pedagogical decisions. My goal was to promote not only the best learning experiences for participants but also best practice in pedagogy when I was fulfilling teaching and facilitator roles. Here goes the familiar refrain: You can use concepts anytime, anyplace. How do those of us in formal occupational therapy education roles know when our choice of pedagogy is effective in promoting Learning as Process?

Carnegie Foundation for the Advancement of Teaching

During the past 25 years and through support from the Carnegie Foundation for the Advancement of Teaching, a movement in higher education called the scholarship of teaching and learning has emerged in which the focus has been exploring pedagogical approaches that promote effective learning in a variety of contexts. The scholarship of teaching and learning rests along a continuum that promotes excellence in teaching to fully fledged programs of educational research. For many of us, this approach to examining pedagogy is a systematic way to improve how we facilitate learning during professional education. Another challenge for professional education is examining and ulti- mately fostering how learners grapple with understanding and practicing their disciplinary ways of thinking, or habits of the mind (Chick, Haynie, & Gurung, 2008, p. 2).

Also supported by the Carnegie Foundation for the Advancement of Teaching, the Preparation for the Profes- sions program explored how and which pedagogies influenced how professionals-in-the-making learn and develop into fledgling professionals. Professions under study were clergy, lawyers, engineers, nurses, and physicians. Lee Shul- man (2005) coined the term signature pedagogies, meaning “the types of teaching that organize the fundamental ways in which future practitioners are educated for their new professions” (p. 52). This definition requires that both learners and teachers reframe their thinking.

Although occupational therapy was not one of the professions studied in the Carnegie project, Schaber, Marsh, and Wilcox (2012) have begun a conversation in occupational therapy around three particular pedagogies often used in our educational programs: active learning, relational learning, and contextualized learning. These three signature pedagogies require effective instructional design and facilitation if they are to promote effective learn- ing for occupational therapy students. We learn by doing, we learn by relating to others, and we learn by context, finding our place in the profession over time, first as student, next as practitioner, then as expert and hopefully mentor.

Before we get too comfortable and think we have a handy solution, let me suggest that several of our colleagues in other health professions could, would, and should make much the same argument about these particular signa- ture pedagogies. They are, indeed, great ways to facilitate a range of cognitive, psychomotor, and affective learning.

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My concern is how to take these signature pedagogies and anchor them to what is unique about occupational ther- apy and create best practice for developing requisite habits of the mind. How do we select signature pedagogies that will help our students learn these habits of mind that support our profession?

One of the first habits of mind our students must develop is skill in using the profession’s unique filter, which for occupational therapy is occupation. First, learners must practice seeing through an occupational lens. Our occu- pational lens, the way in which we see people participating in and fulfilling their desire to engage in occupations of meaning, is what makes our contribution unique. No other profession sees this way. Next, learners must practice lis- tening through their occupational ears, the way in which we listen to the stories of people’s occupational lives. No other profession listens this way. Finally, we must develop reasoning through our occupational mind and critically think about the way occupational dysfunction or occupational deprivation presents itself so we can generate possi- ble solutions that are acceptable to the lives of our service recipients (Alison Wicks, informal class presentation, Med- ical University of South Carolina, 2005). No other profession sees, listens, and thinks this way. We are the only profession dedicated to meeting the occupational needs of society (Gillette, 2002).

Pedagogies that promote opportunities for learners to explicitly see, listen, and think about occupation through our professional filter first and record such findings are essential, as are opportunities to build confidence by dis- cussing such findings with other health professions. Obviously, this is not the only time we want our pedagogies to support the learning connection to occupation; however, I predict if we do not start off with this conceptual orien- tation for our learners, then we have missed the core of our uniqueness. Part of the challenge is helping faculty mem- bers examine their own pedagogical choices and explore ways to center occupation at the core of their courses, thereby strengthening their ability to develop learners’ ways of thinking or habits of mind.

Center for Occupational Therapy Education at Colorado State University

Barbara Hooper leads the Center for Occupational Therapy Education at Colorado State University (http:// www .cote.chhs.colostate.edu/). The center is aggregating a repository of educational resources and conducting pedagogi- cal institutes. The educational team includes Barbara Hooper and Wendy Wood from Colorado State University and faculty members from other institutions: Andrea Bilics, Worcester State University; Steven Taff, Washington Univer- sity; and myself, Medical University of South Carolina. The ongoing pedagogical work we do during our faculty devel- opment institutes is to help occupational therapy faculty members see more explicitly what they are doing in their instructional repertoire and practice. Participants bring their own coursework with them and work with it through- out the institutes. Central to the work is our commitment to the belief that professions have a core body of knowl- edge that is named in the lexicon of the profession and becomes the differentiator from other professions, much as I described using the term professional filter. For occupational therapy, our core body of knowledge is occupation, which is predicated on the profession’s basic philosophic beliefs that humans are occupational beings, neurologically wired to explore and master their environments (Wilcock, 2006).

Occupational science is now a progressive discipline that underpins occupational therapy, much the same way that pharmacology underpins the profession of pharmacy. What is fascinating about occupational science is that it began its development about 30 years ago, after the inception of the profession, as a way to organize what we thought we knew implicitly about occupation and generate ways to study it more explicitly (Pierce, 2014; Zemke & Clark, 2006). Now we have access to what our founders did not have: a basic discipline to inform our practice and evidence to sus- tain the profession as it moves forward into the 21st century. Now we know more about occupation as an active mul- tidimensional construct with its physiological, neurological, psychological, cognitive, and social components. It is this emerging knowledge that allowed Yerxa (1998) to sound the clarion call when she proposed a renaissance in occupa- tion as the curriculum keystone for a self-defined profession and, I would add, a profession with its own unique filter.

Moreover, through the Center for Occupational Therapy Education and with a national team of researchers including Andrea Bilics, Barbara Hooper, Sheama Krishnagiri, Polly Price, Steven Taff, and myself, Dr. Hooper launched the first national research study examining how occupation is addressed in occupational therapy

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curricula (Hooper et al., 2013). This study is predicated on Hooper’s seminal work during the past several years (see Hooper, 2006a, 2006b, 2010), examining the epistemology of knowledge in occupational therapy and in translating and explicating the work of Baxter Magolda (1999) on self-authorship and on subject- centered edu- cation by Parker Palmer (1998). Hooper’s efforts have created clearer strategies for learning and teaching in occu- pational therapy.

Through Hooper’s work, we have learned more about Palmer (1998), educator and thought leader, who was the first to coin the phrase the one great thing (p. 119) that serves as the central organizer, without which informational chaos reigns and learning is fragmented. The idea that there is a core subject to which all other topics relate is called subject-centered learning. The one great thing for occupational therapy is occupation, not all and anything related to occupation. The one great thing for occupational therapy reaffirms that occupation, albeit a multidimensional con- struct, is the original, ongoing, and central construct around which the profession originated, developed, and lives on. Through Hooper’s translational work and development of a model for subject-centered learning, we can now actively live out our one great thing and help our learners do the same.

One of the toughest challenges in occupational therapy is to talk explicitly about what seems so evident to us because we assume it’s evident to everyone else, including our learners. Because of embarrassment or lack of confi- dence in quotidian fare, Whiteford and Wilcock (2001) have noted we can easily obscure the core of occupation with other, albeit important and relevant, topics. Occupation becomes background and a given topic becomes foreground rather than the other way around. I have seen examples of curriculum designs that are not occupation centered and in which occupation is a curriculum thread rather than the core subject of an educational program; sometimes there is no core subject, and occupation merely weaves in and out of topics at will, often depending on instructor prefer- ence. Taking these concepts out into the practice milieu, Fisher (2013) argued for clarity by proposing a short tax- onomy in descending order from occupation centered to occupation based to occupation focused.

Keeping topics such as anatomy, clinical conditions, evidence-based practice, interventions, administration, and ethics in a curriculum, and all with equal valence to occupation, does not promote occupation as our unique focus, especially when faculty members outside our field may be teaching such topics. Often, they are not well versed in occupation, if at all, and they do not think and speak that way. Many other health professions study these relevant topics, too, and the knowledge gained by learners provides needed and common understanding when occupational therapists work together in health care teams. The challenge as I see it is twofold: (1) How do we facilitate Learning as Process about occupation as the core of our profession and (2) how do we facilitate Learning as Process about important and relevant topics in direct relation to the core? Are some of the pedagogies we use and the signature active, relational, and contextual learning pedagogies described by Schaber et al. (2012) sufficient to accomplish this twofold challenge?

Think and Link

Hooper (2013) showed very clearly the relationship of core to topics and topics to core (Figure 65.3). I agree strongly with Hooper (2006a), who advocated for and examined mechanisms that provide ways to tether (her word) these con- nections. I’m choosing to call such connections think and link (my words) and requiring both from instructor and learner alike. Could this type of connecting strategy be considered as signature pedagogy? It is certainly a habit of mind.

Notice how Hooper (2006a) showed the relationship between core and topics set against a contextual backdrop, a community of knowers that will vary every time the instructor identifies the intended learning outcomes. In one of her plenary sessions at the institute, Hooper talked about the constructivist perspective at play and how we are constantly co-constructing new knowledge and letting it go, only to co-construct it again as the situation changes. From a structural standpoint, when an occupational therapy faculty secures occupation as core for its curriculum, it allows agreed-upon parameters to delimit the scope and increase the coherence of content, making it much easier for instructors and students alike. Instructors have an easier time using one voice for writing course titles and descrip- tions, determining the depth and the breadth of course content such that it meets requirements for entry-level

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2014 Eleanor Clarke Slagle Lecture

practice. Pedagogies are selected that promote thinking and linking to the core. Learning assignments are designed to incorporate a range of think-and-link requirements, and assessment strategies, especially rubrics, are used to judge learning outcomes by how well they link to occupation. In my mind, good pedagogy follows the 80–20 rule: 80% thinking and 20% implementing. Our pedagogical focus needs to be learner centered, in the same way our therapy practice is patient or client centered. After we have done our planning, we need to get out of our own way and allow the learners to be the focus of attention once the course is up and running.

Lest you think I’m selling a handy formula (Hooper et al., in press), there are a variety of ways, all a matter of degree, to connect topics to the core and the core to the topics. Let me give you a few examples. Think of an anatomy course, taught by an anatomist. I’m sure many of you have taken such a course and have horror stories to tell about it. The course relies on complete rote memorization, with a little dissection or prosection thrown in for good measure, and there is nothing to suggest any relationship between what is learned and how what is learned may be connected to human occupation. In this example, the topic is completely unconnected to the core, and the core is absent from the topic. No think, no link! Next example: the ubiquitous Introduction to Occupational Therapy course, which is often a potpourri of information about the profession rather than about occupation, its philosophy, history, official documents, theoretical bases, practice settings, and professional organizations. Learners may interview practitioners, prepare a classic 15-second elevator speech on occupational therapy, create a calling card, undertake observations, and synthesize their findings. In this scenario, the topic, occupational therapy as a profession, is connected to occupation as core although rather indirectly, implicitly, and possibly tenuously, leaving learners to think and link without much guidance, putting them at risk for faulty assumptions, thinking, and reasoning. Some think, “Scary link!”

Figure 65.3. Elements of subject-centered learning (Hooper, 2013). Note. From “Plenary Session 1: Integrating Content With the Core Subject of the Profession,” by B. Hooper, June 22, 2013, presented at the Faculty Development Institute Designing Graduate Courses for Integration Learning: Theory, Research, Implementation and Assessment, Colorado State University, Fort Collins. Copyright © 2013 by B. Hooper. Adapted with permission

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This last example has redeeming features. Imagine a Professional Issues course, and the topic of the day is health law and ethics. The guest speaker is a smart lawyer who makes a splendid presentation. As a faculty member, you follow this presentation with a small-group activity (active and relational learning), and assign each group a piece of legislation (contextual learning; remember Schaber et al., 2012), and ask for an argument demonstrating how this piece of legislation enables occupation and whether it ensures occupational justice. What happens to people’s lives when a new piece of legislation comes into law? Here you see that the topic (new legislation) is integrated through an occupational lens and thereby brings to the foreground an explicit connection to occupation by examining the effect the legislation has on people’s lives and the contexts in which they live. Here we give high marks to think and link: to the instructor for the pedagogical planning and to the learners for doing thinking and linking. Good think, good link!

I began Part 2 by recognizing that Learning as Process is personal and highly individualized, and I would be remiss if I did not acknowledge in all I have said that many of us have and continue to benefit from innovations in technology. The literature is replete with examples, experts abound, and I am least qualified in this area. However, we have a wealth of media that support signature pedagogies. Yet with any high-tech approach we need high touch for balance. It is my opinion that the high touch we need for occupational therapy Education as Product is the abil- ity, whenever we are in the teaching and facilitator roles, to connect learning and learners to occupation as the core of our profession. Again, I beg you not to limit your thinking about teaching and facilitator roles to the academic environment. I hope in your mind, and with a few prompts from me, you are still in your own role and context. Without handcrafting these connections carefully across all contexts, without shaping desired learning outcomes in relation to the core, we give away our power for creating the 21st-century occupational therapy as we espouse it in our Centennial Vision.

No matter the context nor the medium of engagement, I trust Learning as Process has shed light on how we can help our learners and those facilitating learning to

• Do more initial occupational filtering so we know what we are seeing, hearing, and thinking before we begin any new learning process;

• Do more cognizant centering of occupation as core for all learning initiatives, especially those that involve ser- vice recipients; and

• Do more explicit planning to promote thinking and linking when we are learning ourselves or facilitating learn- ing for others.

Part 3: Living as Progress

This final concept invites you to see yourself as a living-ologist (my term), looking at lives as they are enacted over time and intervening at key points to transform that which has been disrupted. Living as Progress is a societal and personal journey and the linchpin of our profession. One of the initial engines and power sources of our profession was Eleanor Clarke Slagle. Mrs. Slagle was the recipient of Education as Product and considered a well-educated woman of her time. She came to prominence when the resettlement movement, centered in Hull House in Chicago (Quiroga, 1995), was at its zenith, led by Jane Addams, Ellen Gates Starr, and Julia Lathrop—strong, prominent, pithy women who were at the forefront of significant social change in society. From an initial resettlement house, 12 more such houses flourished. Reflecting on progress and her high standards, and presuming she felt rather pleased with herself on a particular day, Jane Addams is reputed to have said, “The excellent becomes the permanent.”

Mrs. Slagle faced Education as Product at a time similar to the present when a new century was turning over; when society was as befuddled as it is now; and when people’s lives were as deprived, disrupted, distressed, disor- dered, and disabled as they are now, making the notion of life’s journey and Living as Progress a rather formidable

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2014 Eleanor Clarke Slagle Lecture

task. The remnants of armies returning from wars fought far afield were blatantly obvious; many people in urban areas were homeless, living in poverty, or in working conditions that were harsh and paid little; and new waves of immigrants were arriving with little societal infrastructure to support them. Our professional commitment now is as it was for Mrs. Slagle—to help people participate more fully in a life of their choosing and help modify environ- ments that by their very nature create unbearable press, making it close to impossible to function, let alone feel any sense of healthfulness and well-being.

Eleanor Clarke Slagle completed a short course in occupations at the Chicago School of Civics and Philanthropy (Loomis, 1992) and later spent time directing occupational therapy at the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital in Baltimore. She returned to Chicago, started a school of occupations, and grappled with Educa- tion as Product and Learning as Process in her quest to contribute to the development of a societally sanctioned pro- fession for first-generation college-educated women (Quiroga, 1995, p. 37). She became one of the founders of the National Society for the Promotion of Occupational Therapy, now AOTA, which adopted its first set of Minimum Standards for Courses of Training in Occupational Therapy at the annual meeting in Milwaukee in 1923. Opinions varied, according to the committee report. The issue at hand back then (AOTA, 1942) was, How do you set standards that are neither too high nor too low?

Journeying Down the Tracks

What sort of engine did it take to set occupational therapy Education as Product on the right track so it was posi- tioned for maximum societal value and benefit? How well tended was that engine? An engine house is a place of refuge and respite. Much as we need restorative occupations, engines need repair and maintenance so they are able to transmit Education as Product down the line. When we broaden Education as Engine and consider the life course with the engine leading the way, we can pick up the story at any point, as we so often do with our service recipients. For Living as Progress to play out, and before any life journey can begin, much activity takes place in a railway yard, keeping the main railway lines of travel clear.

A switcher engine and the presence of several tracks allow engines and other components of a train to be moved, arranged, and assembled into a desired configuration before starting a new journey or retaking an old one. No mat- ter the starting destination, we need a product or engine that is well designed for efficient travel. How do we assess what our clients want their engines to do for them? How far do they need to journey, with whom, and by when? Would anyone still be interested in a steam or diesel engine and have to carry a fuel source with them? Or would they like to travel more quietly, getting electrical power from an overhead grid along the way? If speed is of the essence, then perhaps a magnetic elevated train may be worth considering. With choice of engine settled, who and what might accompany us on the journey? Do we need to couple passenger cars to the engine so others may travel with us—our family members, our friends, personal assistants, key members of our community? Or do we need to couple boxcars holding supportive items such as adaptive equipment for ease of engagement, mobile technology for effective communication, or wheelchairs for ease of mobility? Will our fully assembled train be ready to move onto the main line for travel?

How do we make a decision about which 21st-century tracks will offer a journey worth taking? What sorts of signals should we be seeking before making such a decision? Typically, we orchestrate an assessment process that harnesses clients’ prior life experience, coping strategies, stress hardiness, and available support mechanisms in addi- tion to considering our own clinical judgment and reviewing available evidence. Although current research may not directly align with the circumstances of a given individual, it does bring a broader perspective to life journeys and successful encounters.

Occupation Station is where we start helping clients select an appropriate destination. With occupation as the referent point, we can promote Learning as Process as the energy source. Does a person, group, or organization have the propensity to know what drives it? Do they have patience, tenacity, endurance, motivation, and resilience, t

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