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Comparison of three program planning variables in continuing education in occupational therapy in British.. Harvey, Laura M. 1982

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COMPARISON OF THREE PROGRAM PLANNING VARIABLES IN CONTINUING EDUCATION IN OCCUPATIONAL THERAPY IN BRITISH COLUMBIA by LAURA M. HARVEY B.Sc.O.T., The U n i v e r s i t y o f A l b e r t a , 1978  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE  REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in  THE  FACULTY OF GRADUATE STUDIES  (Department of A d u l t  Education)  We accept t h i s t h e s i s as conforming to the r e q u i r e d standard  THE  UNIVERSITY OF BRITISH COLUMBIA May 19 82  (c) Laura M. Harvey, 19 82  In  presenting  requirements  this thesis f o r an  of  British  it  freely available  agree t h a t for  for  that  Library  shall  for reference  and  study.  I  for extensive  copying  be  her or  shall  publication  not  be  DE-6  (2/79)  of  Columbia  make  further this  thesis  head o f  this  my  It is thesis  a l l o w e d w i t h o u t my  of  The U n i v e r s i t y o f B r i t i s h 2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5  the  representatives.  permission.  Department  copying of  g r a n t e d by  the  University  the  h i s or  f i n a n c i a l gain  the  that  p u r p o s e s may by  f u l f i l m e n t of  degree at  I agree  permission  department or understood  advanced  Columbia,  scholarly  in partial  written  ABSTRACT  The  purpose of t h i s i n v e s t i g a t i o n was  important to the design for  clinical  of e f f e c t i v e c o n t i n u i n g education  occupational therapists.  t h e r a p i s t s ' p r o f e s s i o n a l r o l e and program planning were:  The  r e l a t i o n s h i p s between  The  A secondary purpose was  upon which to base c o n t i n u i n g  therapists in British The  t o gather education  the B r i t i s h Columbia S o c i e t y of Occupational  v a r i a b l e s and  Therapists.  An  the use  therapists:  on three  planning  The  based on the assessment of the  These competencies focused  procedures, and  gap  30, competency  skill  evaluation,  of t h e r a p e u t i c equipment and  areas  therapeutic materials.  c a t e g o r i e s o f b a r r i e r s to p a r t i c i p a t i o n s t u d i e d were  situational i n time) and  (those  a r i s i n g from one's s i t u a t i o n at a given p o i n t  institutional  (those p l a n n i n g p r a c t i c e s and  dures which prevent p a r t i c i p a t i o n ) . system, a comparison was distance  a l l members of  d e s i r e d l e v e l of e x p e r t i s e on  f r e q u e n t l y used by c l i n i c a l  two  opportunities  a number of respondent c h a r a c t e r i s t i c s .  between e x i s t i n g and  The  specific  developed which examined the three program  l e a r n i n g needs s e c t i o n was  statements.  preferred  Columbia.  sample f o r t h i s d e s c r i p t i v e study was  instrument was  three  selected variables  l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and  information  programs  geographic l o c a t i o n and  v a r i a b l e s were examined.  d e l i v e r y systems.  for  to study v a r i a b l e s  systems.  proce-  In r e l a t i o n t o d e l i v e r y  made between s e l e c t e d d i r e c t  and  iii  The the  r a n k - o r d e r i n g of l e a r n i n g needs r e v e a l e d  competency area i n which the g r e a t e s t  l a r l y evaluation function.  need e x i s t e d ,  of perceptual-motor, c o g n i t i v e  Vocational  assessment and  and  treatment was  as a p r i o r i t y f o r planners when the h i g h l e a r n i n g of t r a i n i n g o p p o r t u n i t i e s indicated  evaluation  particu-  sensory also reported  need and  were both c o n s i d e r e d .  as  The  lack  findings  s i t u a t i o n a l b a r r i e r s t o p a r t i c i p a t i o n were most f r e -  quently encountered by the respondents with f a m i l y r e s p o n s i b i l i t y and  l a c k of time r e c e i v i n g the h i g h e s t r a n k i n g .  p r e f e r e n c e of d e l i v e r y system was  and  r u r a l therapists  studied.  Of the  differences  systems.  therapists  or between urban  i n r e l a t i o n to the p l a n n i n g  seven hypotheses s t u d i e d ,  supported at the  t h i s study. The  supervisory  percep-  variables  only the one  suggesting  i n b a r r i e r s t o p a r t i c i p a t i o n between urban and  t h e r a p i s t s was for  delivery  s i g n i f i c a n t d i f f e r e n c e s were found between the  t i o n s of c l i n i c a l and  overwhelming  the workshop; respondents  i n d i c a t e d minimal i n t e r e s t i n d i s t a n c e Few  The  rural  l e v e l of s i g n i f i c a n c e adopted  '  major i m p l i c a t i o n  of t h i s study i s the  utility  of  super-  v i s o r s as a source of i n f o r m a t i o n f o r p l a n n i n g programs f o r clinical  therapists.  t o o l s was  The  need f o r d e v e l o p i n g new  a l s o suggested by the  c o n t i n u e d use  findings  of the  increasing the  study.  of workshops as a major d e l i v e r y system,  of geographic l o c a t i o n of the t h e r a p i s t , was e r i n g the  assessment  supported.  The regardless Consid-  l i m i t e d r e s o u r c e s a v a i l a b l e , planners should emphasize the numbers of p a r t i c i p a n t s and  introduction  of i n n o v a t i v e  programs.  whenever  possible,  iv  TABLE OF CONTENTS Page ABSTRACT  i i  LIST OF TABLES  v i i  ACKNOWLEDGEMENTS  viii  CHAPTER I  INTRODUCTION AND PROBLEM DEFINITION P r o f e s s i o n a l Role and Continuing Education Learning Needs B a r r i e r s to P a r t i c i p a t i o n D e l i v e r y Systems Geographic L o c a t i o n and Continuing Education Problem Summary S i g n i f i c a n c e of the Study Research Questions  II  RELATED LITERATURE Introduction Continuing E d u c a t i o n i n O c c u p a t i o n a l Therapy P r o f e s s i o n a l Role and C o n t i n u i n g Education Geographic L o c a t i o n and Continuing Education Learning Needs Needs Assessment Barriers to Participation D e l i v e r y Systems D i r e c t D e l i v e r y Systems D i s t a n c e D e l i v e r y Systems Systems i n C o n t i n u i n g Education Summary of R e l a t e d L i t e r a t u r e  1 2 3 6 8 9 10 11 15 17 17 18 20 24 28 31 36 41 43 44 46 51.  V  CHAPTER III  METHOD S e t t i n g of Study Design Hypotheses Sample Data C o l l e c t i o n Instrumentation Section I Section I I Section I I I P i l o t Test of Instrument Procedures Data A n a l y s i s  IV  RESULTS Response Rate C h a r a c t e r i s t i c s of Respondents P r o f e s s i o n a l Role S t a f f Size Years of Employment Geographic L o c a t i o n Opportunity f o r P r o f e s s i o n a l Contacts L e a r n i n g Needs Relevance of Competencies A v a i l a b i l i t y of T r a i n i n g Opportunities Barriers to P a r t i c i p a t i o n D e l i v e r y Systems Tests o f Hypotheses Summary of R e s u l t s  V  DISCUSSION AND CONCLUSIONS P r o f e s s i o n a l Role and C o n t i n u i n g Education Learning Needs Barriers to P a r t i c i p a t i o n D e l i v e r y Systems Geographic L o c a t i o n and C o n t i n u i n g Education L e a r n i n g Needs Barriers to Participation D e l i v e r y Systems  53 53 54 54 54 59 59 60 62 63 67 68 69 71 71 72 73 75 77 78 81 81 87 91 95 98 102 106 108 109 110 114 115 118 119 122 123  vi  Assessment Tool L i m i t a t i o n s of Research Design Implications Recommendations f o r F u r t h e r Study  125 128 129 134  REFERENCES  137  REFERENCE NOTES  144  APPENDICES  145  Appendix A - Q u e s t i o n n a i r e  145  Appendix B - L e t t e r s of T r a n s m i t t a l  150  Appendix C - L e t t e r of Support  153  vii  LIST OF TABLES TABLE 1 2 3  Page D i s t r i b u t i o n of Occupational by Job T i t l e  Therapists 74  Number of Occupational T h e r a p i s t s Respondent's D i r e c t i o n D i s t r i b u t i o n of Occupational by Geographic L o c a t i o n  Under 76  Therapists  4  D i s t r i b u t i o n of T h e r a p i s t s ' P r o f e s s i o n a l Role by Geographic L o c a t i o n  5  Number of O p p o r t u n i t i e s  79 80  f o r Professional  Contact w i t h Other Occupational T h e r a p i s t s  83  6  T o t a l Need Estimate by P r o f e s s i o n a l Role  84  7  T o t a l Need Estimate by Geographic L o c a t i o n  85  8  Relevance o f Competencies by P r o f e s s i o n a l Role Relevance of Competencies by Geographic Location  9 10 11  Perceived A v a i l a b i l i t y P r o f e s s i o n a l Role  of T r a i n i n g by  Perceived A v a i l a b i l i t y Geographic L o c a t i o n  of T r a i n i n g by  88 89 92 93  12  Ranking Perceived B a r r i e r s t o P a r t i c i p a t i o n 96 by P r o f e s s i o n a l Role  13  Ranking Perceived B a r r i e r s t o P a r t i c i p a t i o n by Geographic L o c a t i o n 97  14  Ranking P r e f e r r e d D e l i v e r y P r o f e s s i o n a l Role  Systems by  Ranking P r e f e r r e d D e l i v e r y Geographic L o c a t i o n  Systems by  15  100 101  viii ACKNOWLEDGEMENTS  I wish t o express my s i n c e r e a p p r e c i a t i o n t o a "number o f people whose c o n t r i b u t i o n s made t h i s study p o s s i b l e . In p a r t i c u l a r , t o my committee members, Dr. T. Sork and Dr. D. F i e l d i n g without whose l e a r n e d counsel and p a t i e n c e , progress would not have been p o s s i b l e . To Dr. Margaret Moreau f o r h e r s t a t i s t i c a l Saturday mornings, For  e x p e r t i s e and  I am indebted.  t h e i r u n f a i l i n g support and understanding i n the face  of numerous c r i s e s , I thank l a f a m i l l e  Martz.  F i n a l l y , I wish t o acknowledge my b r o t h e r , Gordon, whose s c h o l a r l y example i n s p i r e d me t o take on t h i s t a s k .  1  CHAPTER ONE  INTRODUCTION AND PROBLEM DEFINITION  The  u l t i m a t e goal of c o n t i n u i n g education  therapists therapist  i s to maximize the w e l l - b e i n g  dissemination,  professionals  maintain  r a p i d l y changing f i e l d  f o r whom the  continuing  and of  increase  health  education  their  care.  of the t h e r a p i s t ,  knowledge  competence i n the  Unless  and  helps  an  education  the previous  skills  may  soon  outdated.  In  spite  of the c u r r e n t acknowledgement of the importance  of c o n t i n u i n g p r o f e s s i o n a l education and  of those  i s a v a i l a b l e which b u i l d s upon or m o d i f i e s  experience become  occupational  i s p r o f e s s i o n a l l y r e s p o n s i b l e . As a p r i n c i p l e means of  knowledge  system  for  their  provision greatest  employers, of  these  problem  there  by o c c u p a t i o n a l  therapists  e x i s t a number of problems i n the  educational  opportunities.  i s that o f t e n program planning  by an i n d i v i d u a l as a r e s p o n s i b i l i t y  By  f a r the  i s c a r r i e d out  secondary to another  role.  Common s i t u a t i o n s include the c l i n i c i a n who heads the c o n t i n u i n g education  committee of the l o c a l p r o f e s s i o n a l o r g a n i z a t i o n on a  v o l u n t a r y b a s i s or the f a c u l t y member who devotes week t o planning recognized design  and  that  c o n t i n u i n g education professionals  conduct  learning  backgrounds, the m a j o r i t y having  one  day per  ( B r i n t n e l l , Note 1 ) . I t i s  who have t h i s r e s p o n s i b i l i t y t o opportunities  possess  varied  minimal or no t r a i n i n g i n a d u l t  2  education  or  although result of  program  planning  participation  given  f o r which a t t e n d e n c e (1979)  Madill  the  She  the in  lack  of  baseline  the  information  distribution  planners  are  at present.  among  of  different  information  the primary  continuing  occupational needs,  As  continuing  to  well,  regarding  implications.  The  as a  significant  their  approaching  needs  to  problems  in  process  and  in  studied  was t o examine r e l e v a n t to the for  clinical  preferred  therapists of  delivery  p e r c e p t i o n s of  professional  for  their  role  program  information  in British  Columbia.  the  Role  major  and  planning  In a d d i t i o n , a secondary purpose o f the study  specific  of  study  s e l e c t e d v a r i a b l e s were l e a r n i n g  function  were  Professional  One  the  opportunities  participation,  location  generate  education  differences  education  geographic  therapists  and t h e l a c k o f  g r o u p s o f t h e r a p i s t s and  purpose of t h i s  therapists.  barriers  systems.  education.  She s t r e s s e s t h e g a t h e r i n g  v a r i a b l e s of t h e p r o g r a m p l a n n i n g  design  facing  education.  Therefore,  to  of  continuing  range p l a n n i n g  systems  about  planning  difficulties  of  a s one method o f p r a c t i c a l l y  continuing  three  long  delivery  p r o b l e m s t o be c o n f r o n t e d of  to the systematic  summarizes  t h e r a p i s t s i n the f i e l d  flexibility  Therefore,  i s sought.  occupational states  1969).  of t h e r a p i s t s i s s t r o n g l y e n c o u r a g e d , t h e  i s o f t e n a low p r i o r i t y  programs  (Dowling,  was  upon w h i c h t o base p r o g r a m s f o r  and C o n t i n u i n g  problems  that  Education  confronts  the program  3  planner  i s d e c i d i n g upon  which  d e c i s i o n s . Although i t i s an of  planning  models  primary source from and  a  number  thus  of  alternative save  of  potential  on  in  information,  practical used  and  help  to  the  in o c c u p a t i o n a l  money  is  to  the  planner.  therapy  solicit  which  source  of  been addressed in the Griffith,  the  from  1978)  but  in perceptions needs  and  in order  of  to  of a d u l t  has  preferences  The base  education  received  clinical  to  supervisory  information  field  One  supervise.  area of h e a l t h c a r e . This study  education  c l i n i c i a n s and  majority  in nature  determine i f s i m i l a r i t y continuing  in the  of p r a c t i t i o n e r s i s o f t e n c o n f l i c t i n g  has  attention  planning  p a r t i c i p a n t s are  information about the c l i n i c i a n s they  1977;  little  attempted to therapists'  were  held  by  supervisors.  Needs  Need has an e x i s t i n g  been d e f i n e d by Bradshaw  l e v e l of s k i l l  distinguishes  between  wants or d e s i r e s , and objective  assumption  base  gathered  little  (Monette,  Learning  to  information  problem of determining programs  the  planning  time  therapists  implicit  that  commonly  both  information  (1974) as the gap  or knowledge and  felt  needs,  a  desired  between one.  He  a s u b j e c t i v e assessment of  normative needs, which are  e v a l u a t i o n of an expert. One  based  on  the  program p l a n n i n g area in  which p r o f e s s i o n a l r o l e c o n t r i b u t e s to d i f f e r e n c e s i n p e r c e p t i o n i s l e a r n i n g needs. learning their health  needs  in  Differences  in  perception  c o n t i n u i n g education  of  clinicians'  held by c l i n i c i a n s  s u p e r v i s o r s i s the c o n f l i c t most f r e q u e n t l y c i t e d care  literature.  Chatham  ('1979)  suggests  in  and the that  4  discrepancies supervisors  in perception  in five  acknowledges area  of  allied  differences  perhaps  in  most  potential planning  report,  is  skills  or  often  step  Smallegen  two  and  (1981)  groups w i t h i n  described  i n program  that  as a f e l t  of t h e i r  felt  According  to  the p o t e n t i a l p a r t i c i p a n t  interests. clinical  therapists,  the  logical  t h e r a p i s t s themselves  relevant  information  individuals Atwood  not t h e most  suggest  that of  on  the  may  be  use  identification  of  i s a necessary  i n d i v i d u a l s may  knowledge  of  most  often  felt  need as d e f i n e d .  self-  underlying  need  for learning  specific  Knowles  their  Houle  to attend  those  personal  the  needs  education  a s s u m p t i o n would be  the  (1970) and  continuing  best  and for  be t h a t  the  source  of  by t h e f a c t own  planning  need  Nakamoto  that  learning  (1980) c o n t e n d t h a t  or may  f o r c o m p a r i s o n . In a d d i t i o n , represent  i s b a s e d on  need. needs  information.  They  their  be unaware of t h e  present standard  the i n t e r e s t i n v e n t o r i e s assessments (1973)  few  felt  be u n a b l e t o e v a l u a t e  or s k i l l  step  by  influenced  level  learning  m o d e l s . The  influenced  of i d e n t i f y i n g t h e i r  source  and  needs.  (1971) and Knox valid  first  is  would  learning  however,  are capable  and E l l i s  that  needs  to  providing  clinical  Relevancy,  planning  i s more l i k e l y  appear' r e l a t e d  In t h e c a s e of  the  need a s s e s s m e n t . An  participation  perception  that  as  p r o g r a m s . When a s s e s s m e n t  knowledge.  activities  level  these  participant's learning  i t i s described  individual's  are  while  i s b a s e d on t h e i d e a  relevant  assumption  (1972)  fields  between  is  important  needs a s s e s s m e n t  the  health  clinicians  nursing.  Needs a s s e s s m e n t  of  of need e x i s t between  states  rarely that  that  assess  b e c a u s e of  5  this  inability  program  planner  from o t h e r  should  consider  study  need  focused  which  is  perception  of  education.  T h i s was  to  the  provide  field  need.  of  role  some  the  information  settings,  leaders  degree  In o r d e r  a number which  t h a n does t h a t consider  needs  need,  of c l i n i c a l  the  the  be  limited  not  supervisors,  position  therapist  therapist by  in  a  provide  use the  a  most  the  variety  whose  as  in  has of  f o r assessment  inexperience.  of  by  able  typically  a more o b j e c t i v e b a s i s  clinical  continuing  i n t h e a s s e s s m e n t of  p r a c t i c e , often  i t s frequency  may  in  a supervisory  therapy,  therapist's  t h e r a p i s t s are  objectivity  to reach  of y e a r s  may  despite  assessment,  of  provides of  needs  b a s e d on t h e r a t i o n a l e t h a t as  of  of n o r m a t i v e l e a r n i n g  as the s u p e r v i s o r y  therapists'  occupational  accumulated  felt  additional  identification defined  clinical  of t h e i r  learning  needs,  on one a l t e r n a t i v e t o t h e a s s e s s m e n t  n e e d s . N o r m a t i v e need was  virtue  obtaining  own  sources.  This felt  of i n d i v i d u a l s t o d e t e r m i n e t h e i r  ability  to  Assessment  of  form valid  of  needs  source  of  information. The the  v a r i a b l e that  difference  self-assessment occupational factors  was  between  a  is  therapist's  the  therapy.  which  influence education,  work s e t t i n g .  He  In  the  years  (1980)  as  including  of  need  affecting  experience a in  educational that  years  i n f l u e n c e on p e r c e p t i o n  c a s e of t h e r a p i s t s , i t was  of'  identifies  perception  s t a t e s , however,  i s a major  study  n o r m a t i v e l e a r n i n g a s s e s s m e n t and a  Houle  professional  experience  proposed i n t h i s  number  and  professional  of l e a r n i n g  suggested that  of  continuing  background of  in  needs.  t h e l e n g t h of  6  time t h a t  the  t h e r a p i s t had  differences The  study  exist  in  attempted  (felt  clinician's  was  exist  and  and  clinicians  not  program p l a n n i n g  (normative  intended  of  needs).  their  learning  In e x a m i n i n g  to determine which  of p a r t i c i p a t i o n ,  implications this in  supervisors.  significant differences  rather  whether d i f f e r e n c e s between what  and  to  supervising therapists' perception  predictors  to determine  need of  i t was  would c o n t r i b u t e  therapists' perception  l e a r n i n g needs  better  h e l d by  t o d e t e r m i n e whether  needs)  differences, were  perception  between c l i n i c a l  needs  been p r a c t i s i n g  continuing  may  these  perceptions the  felt  of  objective  and  normative  have f o r the p r a c t i s e  education  in  occupational  therapy.  Barriers  to P a r t i c i p a t i o n  Whether barriers  differences  in  to p a r t i c i p a t i o n  question  which  was  perceptions  in  continuing  addressed.  considered  as  essential  identifying  the  f a c t o r s w h i c h may  some  basis  order  to  be  considered  planning from  as:  at a given  p r a c t i s e s and  t o the  a potential In  point  prevent  of  the  the  (Cross,  is  factor  not  arising  provides  of p r o g r a m i n  from  institutional,  self-  or  about  own  program  individual  dispositional,  perceptions  can  one's  those  which d i s c o u r a g e t h e  program;  be  models,  participation type  of  another  may  planning  present  those  procedures  terms  B a r r i e r s to p a r t i c i p a t i o n  i n time;  a t t i t u d e s and  learner  terms  in  this  program  participation.  situational,  participating  related  the  in  education  Although  upon w h i c h t o m o d i f y  facilitate  situation  in  exist  those  oneself  as  barriers  to  1980).  differences  in  perception  of  7  participation  the  consideration. position  role  The  of  the  therapist  therapist having  in the f i e l d of o c c u p a t i o n a l  developed  a  strong  education.  This  increased  personal  commitment  commitment  orientation  the  partially education (White,  due  to  supervisory  toward  a  have  of c o n t i n u i n g  partially  on  career as jobs  undertaken  and  the n e c e s s i t y of p a r t i c i p a t i n g maintaining  an with  would  be  in c o n t i n u i n g such p o s i t i o n s  1975).  Because of the situational  priority  b a r r i e r s , such  given as  which are  continuing  clinical  their  initial  therapists,  occupational  therapy  support  have l e s s than f i v e years therapists  with  more  (Maxwell,  considered  however,  may  in  this  the  the  be l e s s . The  therapist.  For  length of time s i n c e thus  the  necessity  employment p a t t e r n s in  t h i s notion that c l i n i c i a n s tend  experience  experience 1977). study  cost  than the i n s t i t u t i o n a l b a r r i e r s  t r a i n i n g would be minimal and  c o n t i n u i n g education  education,  r e s p o n s i b i l i t y and  f r e q u e n t l y beyond the c o n t r o l of  many  positions  to  family  would l i k e l y be l e s s s i g n i f i c a n t  of  a  notion  based  as a means of o b t a i n i n g and  important  would l i k e l y  be  i n c r e a s i n g l y more r e s p o n s i b i l i t y are  an  reached  therapy  to  would  is  in  tend  the to  be  Dispositional because  of  field  were  not  comparatively  few  instances that they were reported  in  one.  of these b a r r i e r s i s such that  it only  I t i s l i k e l y that the nature is  socially rarely  participation.  unacceptable  indicated  on  studies  that  in s u p e r v i s o r y  barriers  the  and  to  similar  to r e p o r t them, and surveys  as  reasons  to  this  thus they  are  for  non-  8  Delivery An  Systems examination  of  systems f o r c o n t i n u i n g role  of  the  the  therapist  would  continuing  in p r e f e r r e d  education programs is  experience on p e r c e p t i o n . therapists  differences  had  education and  t h e i r exposure to the  based on the  Considering  have  in  the  relation  idea that  more opportunity  to p a r t i c i p a t e i n  need to p a r t i c i p a t e ,  education would be g r e a t e r . When asked to express  likely  to i d e n t i f y a system  occupational  systems,  supervisory which  supervisory  used and  was  therapists  thus  would  technological  p r e f e r the d i s t a n c e In  held  educational  by  relation  familiar  it  could  prefer  be  to  preferred differences  to  delivery were  likely  systems to the  and  needs,  systems viewed  based.  In  been by f a r  expected  that  more access to  traditional  in  supervisory  barriers in  to  continuing  terms  determining the program planner's which programs are  them.  new  t o o l s in t h e i r undergraduate education  therapists  learning  preference  t h i s system. C l i n i c i a n s ,  summary, t h i s study examined d i f f e r e n c e s clinical  continuing  t h e r a p i s t s would be more  however, having fewer experiences and  may  a  therapy the d i r e c t d e l i v e r y system has  the most f r e q u e n t l y  the  supervising  t r a d i t i o n a l d e l i v e r y systems of  delivery  to  i n f l u e n c e of years of  p o s s i b l y a greater  among  delivery  of  source  ones. in  perceptions  therapists  p a r t i c i p a t i o n , and education.  These  their implications of  in  information  for upon  9  Geographic  Another education the  major  programs  case  of  isolation  from  problem  i s the  a  rural  may  participation,  of  the  of  cost  the  areas  and  thus  British  Opportunities  for  at  restricted  present  centers travel. to  are  or  those  who  Ironically,  participate  i t i s those  in  continuing  program a v a i l a b i l i t y travel  to  colleague  larger contact,  institutions,  or  in their centers the  the  seeking  ability  for  as  t o lower  planning  facilitating is  their  designed  utility.  t o meet p r o g r a m b u d g e t s .  The  provides support  the  majority  i s the  Vancouver  two  and  t i m e and  two  are  education  the  or  the  are  access  of  financial  most  programs  in  urban  need. in  to  unable lack  support  common  to formalized  therapy  finances  same t h e r a p i s t s who because  large  Victoria.  in occupational  t o commit  that  often  of  a large  r e s i d i n g in these  area  to  number  that  inservice easy  of  time l a g t h a t  education  able  has  the  Columbia,  are  education  in t h e i r  p o s s i b l e and  to those  the  t o meet  financial  continuing  For  therapists  the  therapist population  in  and  In  Columbia,  3).  terms  problematic  in order  learner.  Note  demands, p r o g r a m s a r e  i s necessary  continuing  British  in  have t e n d e d  many i n d i v i d u a l s a s  participants  urban  as  i n v o l v e d and  such s u r v e y s  financial  participants portion  in  continuing  rural  appear  of  isolated  (Dickson,  regions,  surveying  not  with  needs o f a s  concern  Education  planner  therapists in planning  information  of  the  been made i n a c c e s s i b l e b o t h  Although  Because  for  therapists  outlying  participate.  associated  Continuing  geographically  major  in  historically  and  occupational  is  therapist  input  Location  of to  Without larger  programs,  the  10  opportunity is  less  for rural  than  for  t h e r a p i s t s t o update urban  t h e r a p i s t s . Although  geographic  isolation  attention  i n the distance education  field  This the  study  therapists'  therapists' areas  the  participation, the  determining program  planner  whether  content  the  than  Finally, systems  the  study  needs,  therapy.  barriers  therapists  than  Problem  Summary  planners  some  of  counterparts.  types  the  therapy,  role  have  i n the f i e l d  has  been documented and made a v a i l a b l e t o a s s i s t  of d e l i v e r y  problems  that  little  was  examined  in  this  of  study  planners  information  the planner i n  making d e c i s i o n s upon w h i c h t o base p r o g r a m s . T h e s o u r c e information  need of  of c o n t i n u i n g education i n  of t h e m a r g i n a l  of o c c u p a t i o n a l  different  whether a s a  urban  distance  to address  and  include  are in greater  their  to  implications  require  using  Because  three  therapists  was e x a m i n e d .  the  to  relation  therapy  attempted  confronting  occupational  of  rural  education  t h e r a p i s t s , they  question  and  continuing  urban  programs  in occupational  This practice  education  rural  do  s u b g r o u p of o c c u p a t i o n a l continuing  in  learning  in  variables.  urban  and p r e f e r r e d d e l i v e r y s y s t e m s . The  program  i n the  l o c a t i o n on  planning  between  were c o n s i d e r e d planning:  abundant  research  of geographic  program  differences  program  received  minimal.  the e f f e c t s of  has  skills  the i n f l u e n c e of  literature,  h a s been  perceptions  perceptions  in  learners  therapy  considered  Specifically,  to  on r u r a l  of o c c u p a t i o n a l  knowledge and  of  such  through comparison of  11  perceptions  of  preferences  held  second problem of  clinical by  tendency  centers. were  of  to  these  specific  programs  planning  in British  major courses  that  Hoffman, erosion  the  field  the  this an  the  be  t o be  implications of-baseline  therapy  made  is cited  for  decade  Koonz,  therapy  upon future  a t t e s t s t o the r e a l i t y half-life  of t h i s  i s t h e amount  because  knowledge, becomes r o u g h l y  of  new  the  education  (Hightower,  the p r o f e s s i o n  1973;  due t o t h e  i s a major c o n c e r n i n 1979). The f a c t  i s now e s t i m a t e d fear  as  1978). O b s o l e s c e n c e , o r  (Madill,  knowledge  by many  of c o n t i n u i n g  of once p r o v e n methods,  of m e d i c a l  individual,  urban c o l l e a g u e s  can  proliferation  1980;  of o c c u p a t i o n a l  context,  therapists  o f t h e Study  i n the past  Houle,  value  rural  occupational  decisions  has o c c u r r e d  half-life  years  to  o f t e c h n i c a l knowledge w i t h i n  diminishing  metropolitan  l i e i n the generation  basic  of  Columbia.  behind  1979a;  if  Existing  because  p r o c e d u r e s . The  of p r o f e s s i o n a l o b s o l e s c e n c e  force  education.  in large  from t h e i r  Significance  Fear  isolation  therapists  located  and  therapists. A  geographic  t o determine  problems  needs  clinical  continuing  be  different  on a number of i s s u e s  which  on  f o r s p e c i a l programming  studying  data  them  study attempted  sufficiently  considered  and  inaccessible to rural  for  This  learning  was t h e e f f e c t s of  therapists  programs a r e o f t e n the  supervisors  studied  occupational  therapists'  (Hoffman,  of time t h a t  developments,  h a l f a s competent  that  t o be 1979b).  passes  In  before  techniques  t o do the.  five  and  job f o r  12  which  they  were  occupational skills in  trained.  therapists lies  The  implication  competent  obsolescence, continuing retain  many  medicine,  licence.  that  number  education  programs  mandatory direct.  Although  not  of  forces  are  in  hours  professionals  on t h e a r e a  threat  chosen  in  have  to  America,  introduced  participate in a  certified  continuing  1978). The i n f l u e n c e of  of c o n t i n u i n g  continuing  of o c c u p a t i o n a l  education  education  therapy,  unprecedented  is  i s y e t t o be  and  therefore  i n f l u e n c e on t h e g r o w t h o f t h e f i e l d , an  of  t o make  i n North  pharmacy  annually  their  for p r a c t i t i o n e r s to  ( S t r o s s and H a r l a n ,  creating  for  to practise  the  have  order  and  legislated  a direct  to  groups  nursing,  i n the f i e l d  is  i n order  I n many j u r i s d i c t i o n s  participation  introduced  care  requires of  basis  response  mandatory  dentistry,  legislation  In  health  education  their  minimum  manner.  this  i n the n e c e s s i t y of updating  a n d knowledge on a c o n t i n u o u s  a  of  demand  a number  for  such  opportun i t i es. Cooper the  field  that  (1973)  of health care  the p r o f e s s i o n  on  the  and  the p o p u l a t i o n of  turnover  be  serves.  the  as  direct  and i n d i r e c t  a  whole.  trends  For  is  field  have t h e i r  a  factor  impact  the  i n high  both  society  increased employment  w h i c h has i m p l i c a t i o n s f o r t h e  of the p o p u l a t i o n  of programs. C o n s i d e r i n g  society  group w i t h i n  example,  of o r i e n t a t i o n - r e l a t e d c o n t i n u i n g  t h e age of 65 y e a r s  changes i n  from a l t e r a t i o n s i n the  Social  population  t h e age d i s t r i b u t i o n  over  result  i n the h e a l t h care  frequency  content  that  h e a l t h p r o f e s s i o n a l s as a d i s t i n c t  mobility  in  states  that  education.  is  The s h i f t  important  to the  12% o f t h e p o p u l a t i o n  by t h e y e a r  2001 ( M a r s h a l l ,  will  1980),  13  gerontological this  issues  social  therapists  trend  has  Matthews  of c o n t i n u i n g  for  more and b e t t e r  education health  care  education  in  programs  the  dealing  health  care  Another associated  care.  expansion  of  necessitate knowledge learning  the  to  these  disabilities  within  a new  Werdt,  1980).  In  within  role  heightened  current  upsurge of  continuing public  education  lobby,  been  The  change  for continuing  and  i n focus  by f i n a n c i a l education  new  in a l l areas  diversification workers  recent  and  which  may  s k i l l s and to  s y s t e m , f o r example,  has  (Levangie,  1980; Punwar and  o f government support,  can  settings  competencies  placing  care  attention  of m u l t i p l e  thereby  is  health  policy,  dual  quite  increase  t h r o u g h c h a n g i n g manpower  administrative  setting  The  that  i s government  introduced  care  the school  t o the i n f l u e n c e  clinical each  roles.  practise  this.  involvement  health  f o r the t h e r a p i s t  accompanied  addition  both  i n t h e d e l i v e r y of  of  facilitated  of  fulfill  frequently  Continuing  t h e p r a c t i t i o n e r ' s l e a r n i n g or r e l e a r n i n g  created  demand  roles  demands  public's  The  illustration  systems have has  pressure.  by t h e  due t o p u b l i c  This  long  the s o c i e t a l  a s p e c t s of p r o f e s s i o n a l  the i n c r e a s i n g  and d e l i v e r y  a  increasing  by c h a n g e s  health.  influencing  Partially  after  (1979) d e s c r i b e  been c r e a t e d of  addition  t h e r e a c t i v a t i o n of  force  public  necessitated  field  force  health  work  In  a r e r e s u l t i n g i n i n c r e a s i n g use  to s a t i s f y  with the l e g a l  with  programs  care  i s an e x c e l l e n t  intervention.  of  is  for  by s t a t i n g t h a t  health  w h i c h have  awareness  in  education  then,  the  and S c h u m a s t e r s  role  continuing  more p r e v a l e n t .  implications  who w i s h t o r e - e n t e r  absence.  of  a r e becoming  the  needs.  for practise, are  demands  required on  the  1 4  continuing  education  Changing  programs.  employment  on  increasing  incidences of part-time  in  the  field  continuing  of  impact  of t h i s  within the health care  i n f l u e n c e on  competency. equipment  developments  have  rendered  Basic  adequately  states care  are also  continue  techniques,  in  acutely felt  that  from c u r e  i n the  t o have a  to  maintain  field  by  of  occupational c a n no l o n g e r t o be c a r r i e d  updated.  the  lack  developments,  increasingly  professional,  the  complex,  delivery the  worker more d i v e r s i f i e d ,  Woodside  i n t h e f i e l d of of  t h e r a p i s t s would have o p p o r t u n i t y of  i n the  to prevention, a  f o r a l l the r o l e s  exacerbated  knowledge. As a r e s u l t  care  away  t h e p r o b l e m o f advancement  been  having  r e s e a r c h , and  i n o c c u p a t i o n a l therapy  the therapist  which  are  o b s o l e t e many d i a g n o s t i c and t h e r a p e u t i c  n o r c a n i t keep t h e t h e r a p i s t  has  technological  health  itself  professionals  i n procedures,  training  prepare  in practise  becoming  therapy  T e c h n o l o g i c a l advancement and  of  of h e a l t h c a r e  t h a t h a s been  their  and r e - e n t r y t y p e s o f  In a d d i t i o n , t h e r e h a s been a n o t i c e a b l e s h i f t  philosophy  therapy.  noticeable  where t h e m a j o r i t y o f  have a n d w i l l  abi.lilty  Innovations  practises.  programs  field  on c o n t i n u i n g e d u c a t i o n .  profound  health  r e t u r n t o work i n  trend.  medical  (1977)  therapy  social  T r e n d s such as  opportunities in occupational  related  out  employment,  a r e women. Degree c o m p l e t i o n  Changes  shift  another  of c o n t i n u i n g e d u c a t i o n .  occupational  education  one p r o d u c t  whole  is  and m u l t i p l e c a r e e r c h a n g e s a r e e s p e c i a l l y  practitioners  an  area  f o r women  influence  mid-life,  the  patterns  graduate t o update  scientific,  of  and  health  care i s  responsibilities  of t h e  a n d t h e need  for continuing  15  education As  more w i d e s p r e a d .  i n many h e a l t h  period  of  major  professions,  transition,  occupational  one  which  (1979a) i s t o c o n t i n u e . He s u g g e s t s of  older  professionals,  and  the emphasis  to  the  This  public  concern  observed often  for  contribute  i n the future.  professional  competence  among  t o Hoffman  professionals, to the changing  Fear  of t e c h n i c a l  accountability  competency  health  numbers  in  question.  professionals  is  of ways. Among p r a c t i t i o n e r s t h e c o n c e r n i s  in  quality  of f e m a l e  c h a n g e , and i n c r e a s e d  have p l a c e d  reflected  concern  field  social  i n a number  establish  of  rapid  care  according  i s in a  the increasing  the p r o p o r t i o n  on r e - l i c e n s i n g w i l l  n a t u r e of t h e h e a l t h obsolescence,  that  therapy  efforts  to  assurance  describe  programs.  Among  i s r e p r e s e n t e d by t h e d e v e l o p m e n t  existing continuing  education  standards of care or educators,  the  of new and t h e r e f o r m  programs.  Research Quest ions  This  study  planning barriers  was  variables  designed in  to  continuing  investigate education:  t o p a r t i c i p a t i o n and p r e f e r r e d  variables  were  considered  occupational  therapists:  therapists,  rural  therapists.  The  in  study  relation  clinical  clinical  delivery  needs,  systems.  These  four  the  and  program  learning  subgroups of  therapists,  therapists,  addressed  to  three  supervisory  urban  following  clinical research  questions: 1)  Do  learning  differences  in  perceptions  needs e x i s t between c l i n i c a l  of  clinical  therapists  and  therapists' supervisory  16  therapists? 2)  Do  clinical  therapists  different  perceptions  experienced  by c l i n i c a l  therapists  more  participation 3)  Do  and  of  supervisory  the  barriers — t o  therapists?  often  identify  Specifically,  therapists  and  supervisory  barriers  the  supervisory  different  perceptions  of  clinical  therapists?  Specifically,  while  participation do  institutional  have  to  t h a n s i t u a t i o n a l ones?  clinical  more o f t e n  therapists  delivery  clinical  therapists  systems  do  identify direct delivery  therapists  more o f t e n  preferred  supervisory  systems than prefer  have by  therapists  distance  distance  ones  delivery  systems? 4) Do d i f f e r e n c e s urban c l i n i c a l  in learning  6)  Do  have  a higher  t h a n do u r b a n c l i n i c a l  rural  perceptions  exist  therapists  and  barriers  to  of  o v e r a l l need  urban  therapists  participation  Specifically,  situational  b a r r i e r s t o p a r t i c i p a t i o n than  7)  therapists  Do  between rural  in  rural therapists therapists  do r u r a l t h e r a p i s t s  more o f t e n  differences  more  than d i r e c t d e l i v e r y choose d i r e c t  rural  and  choose  preference  systems?  urban  continuing choose  institutional  while  barriers?  delivery  choose d i s t a n c e  systems w h i l e  in  institutional in  have d i f f e r e n t  more o f t e n  and u r b a n t h e r a p i s t s ? often  for continuing  therapists?  education?  urban  between  therapists?  5) Do r u r a l t h e r a p i s t s education  needs  systems e x i s t  Specifically, delivery  therapists  more  do  systems often  17  CHAPTER  TWO  RELATED LITERATURE  This the  review  area  being  continuing other  of r e l a t e d l i t e r a t u r e  i n v e s t i g a t e d . I t summarizes  education  disciplines it  variables  studied,  provides  and  role  and  of o c c u p a t i o n a l  sciences  when  the h y p o t h e s i z e d two  an o v e r v i e w of  the c u r r e n t  b a c k g r o u n d on t h e t h r e e  and on  variables  professional  i n the f i e l d  i n the h e a l t h  addition  these  provides  therapy  and i n  appropriate. program  of  In  planning  relationship  characteristics  geographic  s t a t u s of  between  the  sample,  location.  Introduct ion  A comprehensive although therapy been  the  Panocha  (1979)  a r e employed These  occupational  that  state that  and  of  the  the  research  have  efforts  that  been  the s m a l l  is  in  reveals  in occupational the  area  available  education  or  implemented. size  o f many  that  have  typically describes  Smorynski allied  and  health  number of work s e t t i n g s i n w h i c h  research  restrictions therapy.  education  of c o n t i n u i n g  diverse  limit  literature  continuing  information  the n e c e s s i t y  professions  of  The  programs  education.  for  documented,  minimal.  specific  they  need  i s well  emphasizes  review  would  opportunities appear  in  to apply  continuing t o the  field  18  A  number  amount  of  of  information  Medicine,  nursing,  similar  in  review  of  documentation however,  He are  other  that  data  or  as  being  review  of  in  study  this  in  permit  Acknowledging  the  the  limitations  Continuing  priority of  therapists Madill education  is difficult  to  of  time  and  this on  (1980), education  synthesize.  investigations  few  studies  body  e a c h of  test  describes  limited of the  in Occupational  the  themselves  (1979) summarizes occupational programs,  continuing  education Although  Houle  continuing  because  she  continuing  therapy.  and  publicizing  literature.  the  majority  identifies  learning  in  therapy.  fields.  of  Education  (1977)  consider  the  in  range.  knowledge, major  the  a  variables  presented.  in occupational  lifelong  allow  to o c c u p a t i o n a l  In a d d i t i o n , he  related literature be  to  care  and  in  sufficently  i s b a s e d p r i m a r i l y upon  the  comparison.  are  therapy  of  nature  education.  then,  material  specific  will  Woodside  the  i s because  descriptive  hypotheses  readers  much of this  continuing  findings  health  the  have a s u b s t a n t i a l  in p a r t i c u l a r  related literature, from  states that  on  occupational  research  cautions  literature  however,  pharmacy  to  of  fields  available  and  nature  generalization This  health  that  "finished  i n her  attention  either  identifies  the  at  as  a  the  importance  no  point  can  products."  s t a t e of  therapy  education  emphasizes  notion  the  little in  She  Therapy  the  a r t of  statement has  continuing that  been  Canadian  s e v e r a l areas  beyond  paid or  that  to  American require  19  investigation these  the  statements  which  surveyed on  to  reached  by  important but  is  Murphy  field  the  the  by  work f o r c e  McGregor  (Note  province  distribution  of  of  5)  that  cost  that  was  every the  two short  categorized  generate  found  baseline  and  on  education  study  factors  location.  in relation  as  that  at  to t h e i r  education. and  continuing  that and  time.  least the  in  conclusion is  performance  occupational  Her  i n s e r v i c e education  rank  education  number of  therapists had  been  as A  one  One  title,  total  of  of  her  professional  results  continuing  most h i g h l y  job  the  22  implications for  education  Her  therapists  examined  a major b a r r i e r t o p a r t i c i p a t i n g i n  course and  to  continuing  such and  continuing  utilized  attend years  s t u d i e s were  years.  by  goals,  were a v a i l a b l e a t  therapists  beyond  few  professional  Columbia.  therapists  were c o n s i d e r e d  that  case  but  continuing  that  q u a l i t y of  British  in  was  gathered data  career  were f r e q u e n t l y  a solid  i n a c t i v e t h e r a p i s t s . The  for several  variables  was  the  r e t r a i n i n g t h o s e t h e r a p i s t s who  and  findings  a  i n i n c r e a s i n g the  education  program p l a n n i n g  build  on  in  programs,  attempt  researchers  less influencial  the  only  (1970) c o n s i d e r e d  in upgrading  out  been p u b l i s h e d  education  rationale,  research  education.  these  in the  initiate  these w r i t e r s  continuing  b o t h a c t i v e and  active of  of  t h e r a p i s t s i n an  and  relation  f u r t h e r has  Both  of  continuing  Biers  in  of  t h e r a p i s t s to  nothing  literature. existence  these  data  challenges  t o p i c s , to date  Canadian for  and  journals  sources  and  opportunities suggest  education  favored  major  that  program  methods  were  c o r r e s p o n d e n c e . When l e a r n i n g needs were ordered,  drug  related  information  and  20  perceptual highest  and  learning  Another the  vocational  literature  information  published  by  t h e r a p y . The  Therapists  and  have  described  both  the  competency  systems of  but  the  continuing  professional  Because broad  of  the  and  places  health  to  of  of  are  settings  characterized  McGregor  (Note  observed t y p e of role  so  5)  • that  the  health  care  identification  and  Association  as  a  primary  policy  therapists carry  of  delivery support  Educat ion  diverse  nature  in nature  the  role  health be  out  in  that is  Houle  difficult.  care  system,  identified,  by  an  ordered  L.angwell,  majority  of  institution exists.  (1980) s t a t e s employed  in  structure  Wilson,  and  t h e r a p i s t s are and  that  McGregor's  a  two  clinical  that  of  the  allied  hierarchical of  authority.  Paine  (1981)  employed  i n some  common data  their  grouping  t h e r a p i s t . In h i s d e s c r i p t i o n  frequently  the  statements  s t a t e m e n t s of  professional  professionals  professionals  Occupational  is available.  r o l e d e s c r i p t i o n may  supervising  in  p a r t i c i p a t i o n to  Continuing  that  their  structured  categories  therapist work  according  link  general  education  R o l e and  organizations  needs a s s e s s m e n t , and  beyond t h e s e  work s e t t i n g s a r e  therapists  of  was  Therapy  to p r a c t i c e . T h e i r  professional duties  particular  areas  education  of  education  methods of  Professional  The  Occupational  t h e r a p i s t and  suggest nothing  continuing  professional  continuing  maintainence  goals,  the  American  of  of  on  Canadian A s s o c i a t i o n  responsibility  outline  were c o n s i d e r e d  need.  source of  occupational  assessment  pattern  i n d i c a t e that  of in  21  1975,  28% o f t h e r a p i s t s  hospitals,  24%  hospitals, units.  Within  professional  settings  this  career  direct patient of  care.  is  Within  this hierarchical setting  five  care  supervisory/management  to  y e a r s and t h e n  supervisory  work  to  either  i n order  a  (Stan,  Note  8).  additional  e d u c a t i o n . Baum (1978) d e s c r i b e s  therapy  treatment  situation  which  objectives. clinical so  Because  role,  that  allows of  therapists  they  can  having  process  therapists their  to  therapist  practise  an  achieve  familiarity  their  role rather  transferred  to  the  administrative the  program  and e x p e r t i s e  experience  or  t h e manager o f  a r e promoted t o s u p e r v i s o r y  apply  for a  f o r approximately  than  occupational  is  the supervisory  in clinical  as  other  may  senior  to Stan,  a  they  a number o f y e a r s  services  for  pattern  position  perform  that  to r e f l e c t  therapy  their  i s characterized  tends  occupational  speciality  begin  may  role  t h e common  According  general  hierarchical in  responsible  functions  i n that  assume  position.  or  therapist  therapists'  out  therapist  care,  in  who's p r i m a r y r e s p o n s i b i l i t y  not  of d i r e c t p a t i e n t  psychiatric  24%  therapists  The c l i n i c a l  carry  clinical  centers,  structure,  but  in  c a n be c o n s i d e r e d  The s u p e r v i s o r y  a delegation  employed  extended  as c l i n i c i a n s  duties  professionals. by  rehabilitation  A l l of t h e s e  variety  were  and 22% i n home c a r e ,  structure.  is  in  surveyed  i n the  positions  t o another  s e t of  problems. Based  on t h e d i f f e r e n c e s  clinical  and  differences the  two  supervisory  in  (White,  activities  therapists,  i n p e r c e p t i o n s about  groups  the  1975).  continuing Although  one  performed would  education there  has  by  expect between been no  22  research  i n the  studies  in  suggest  that  to  other  comparison  of  the  the  related  that  management differences  The  (1968) s u g g e s t  of  therapists  perception  between  work w i t h  care  on  to  these  settings  processes There  that  function  of  t h e age o f a p e r s o n i s r o l e s and t h a t  education.  field.  this  Their  management The most  study  and non-  significant  of  preferences  Occupational functions  the  notion  past and  i s described  of a t h e r a p i s t  clinical  be b r o a d e r  settings  appears,  of  their  day b a s i s  therapist's work  (1969)  perceptions  than  (Stan,  of  allied  Note  then,  differences that  be  a  in  although the as a b a s e ,  of d i r e c t  in  a  patient  variety  disciplines  as e s s e n t i a l t o t h e  to  and  8 ) . In a d d i t i o n , t h e  health  in a supervisory  clinical  experience  that  experience  Therapists'  of  these groups. I t i s s t a t e d  should  different  is a  i n the statement  the  support  perspective  supervisory  line  between  care  occur  of  their  day  exist  Association  supervisory  a  attributed  and method o f d e l i v e r y .  description  should  be  and P e r r y  one's  continuing  i n perceptions  supervisor  (1980)  or s u p e r v i s o r y  i n the h e a l t h  Canadian  official  Houle  may  education.  management  program c o n t e n t  of  h a s been p r a c t i s i n g i n  influences  differences  groups  number  of time the i n d i v i d u a l i s i n v o l v e d i n  this  perception that  a  have documented t h i s and  the s u p e r v i s o r  length  their  influences  fields  in perception  clinician.  and S t o r y  to  suggests  that  professional  Castle  care  therapy,  t h e number of c h a n g e s .in c a r e e r  and  continuing  in  the  increased  field  occupational  health  of t i m e  to  that  of  these d i f f e r e n c e s  the length  suggest  area  of  within  decision-making  position.  basis  for differences in  23  perception between these  about  needs and  clinicians  and  their  in  continuing  education  supervisors. Studies  supporting  d i f f e r e n c e s as a f u n c t i o n of p r o f e s s i o n a l r o l e  mainly  carried  out  result  of  almost  the  supervisory  between  study,  the  planning  groups  survey  of  differences  on  whether  persons  programs  o b t a i n i n g and (1981 ) the  identifies  the  conclusions  of  the  must  exist  be  the  identifies  differences  (1975) s t u d y for clinicans  in  on and  the  states  between t h e s e depending  about years  the  of  supervisors  also questions  the  who  because  groups,  different  experience these  in  are  (1967)  which queries  field  may  process  than  and  years  a l s o the  continuing  i n the  of  b a s i s of education  health care  considered  effect  from  groups.  curriculum  be  experts  nursing  and  c o n s t r u c t i o n should  two  educational  perceptions  differences  of  that  i s sought. Staub the  f o r program  upon  s t a t e s t h a t d i f f e r e n c e s i n need a s s e s s m e n t ,  g r o u p . He  program  existence  and  She  utilized  information  ideas  He  each  exist in  for obtaining  practitioners  perceptions  She  or  nurses  developing  as major d i f f e r e n c e s between  These White's  findings  a  Chathan  differences  the  in leadership r o l e s in  different  education  the  in perception  planning  non-leaders.  of  "head"  nurses.  staff  In  practitioners.  methods of p l a n n i n g the  significant and  is likely  of  clinical  been  i s acknowledged.  nurses, these  or  nurses  have  nursing. This  existence  l e a r n i n g needs.  Smallgren  supervise  where  of  information  offerings,  of  "staff"  a study  of  field  universal  relevance  In her  the  and  directors  identification  group  in  nurses  (1979) d e s c r i b e s  have  preferences  teaching  field. method,  separately  of h a v i n g  one  of  for these  24  g r o u p s making d e c i s o n s preferences planners  of  the  should  for  by  it  i s only  in  relation  the  the  the  problem who  to c o n t i n u i n g field  are  disability,  everything  in their  lower  standards  relationship  about  how  opportunities  isolated  since  the  has  been  i t s development,  range  in  the  between  their  suggests  that  geographic  remoteness,  review  of  fact  that  the  the  c h a n c e s of  the  professionals  has  of c o n t i n u i n g  education.  geographic  She  that those  continuing  it  physical  remoteness.  He do  except  to  (1977) d i s c u s s e s  the  remote s t u d e n t ,  will  and  geographic  i n f l u e n c e both  s u c c e s s f u l completion  education  the  who of  barrier  philosophy  a of  and  considered.  literature,  been a b a r r i e r  it  must  t o overcome  distance  on  education  programs  in order a  be  geographic  distance  d e l i v e r y s y s t e m s must be  In her  or  p r o g r a m . Wagner  that  states  existing  reason,  education  observes  of  continuing  power t o h e l p of  (1977)  i n c r e a s i n g l y focussed  whatever  planners  and  Weaver  restriction,  p r o g r a m . He  the  education.  for  p a r t i c i p a t e and  distance  and  perception  learning  education  i s becoming  employment that  will  conclusion  geographically  outside  contends  remoteness  needs  Cont i n u i n g E d u c a t i o n  providing  of a d u l t  facilities  the  comes t o no  d i f f e r e n c e s in  of  are  education  r e c e n t l y t h a t h e a l t h p r o f e s s i o n a l s have c o n s i d e r e d  who  education  continuing  L o c a t i o n and  field  health care  people  but  address these  individuals  addressed  the  other  Geographic  Although  about  to  Nakamoto  (1973)  emphasizes  distribution  of  the  systematic  development  that  effects  observes  the  health  of  25  geographic the  distribution  United  population of  the  States  because  pattern  that  distribution  sponsoring  agencies  The  of  lack  agencies the  funds t h a t of  there  are  groups,  a  British  of  Dickson  sources  of  regional  and  density  and  a  result of  professionals.  communication  i n programming  than  l a r g e number  health  between  these  inefficent  use  education. (Note  of  In  the  reports  that  education  for  3)  continung provincial  h o s p i t a l s , treatment  geographic  approximately  accounted  of  the  professional  centers,  in  stated  facility urban  Victoria  relocate  and  special  this  ways, but  was  who  found  employed  distribution  she  reflected  therapists  (Note 5)  concluded The  the  specialty centers  are  in that  in  a  could  be  that  it  concentration fact  centers  or V a n c o u v e r . T h e r a p i s t s  i s best  Devereaux  that  rehabilitation  away from t h e s e  experience  McGregor  distribution.  areas  h o s p i t a l s and  occupational  therapist population  f o r i n a number of  therapists  of  s t u d i e d by  She  b a s e d on  teaching  location  was  20%  setting.  either  low  Canada. As  exists a  programs t o  therapy,  including:  Columbia  largely  of  a v a i l a b l e for continuing o  number  i n Canada  comparatively  there  and  felt  groups.  The  rural  offering  redundancy  are  the  pattern,  universities,  interest  of  is characteristic  occupational  therapists  more p r o f o u n d l y  co-ordination  creates  case  are  that  are often  where  the  was of  major  located  in  reluctant  to  they  consider  gained.  (1978)  s t a t e s t h a t many o c c u p a t i o n a l  practising  in  rural  areas  graduated  and  are  employment  in a metropolitan  there  of  the  Unites  e i t h e r because area  or  of  States inability  for personal  therapists are  newly  to  secure  reasons.  In  a  26  more in  recent the  study of the geographic d i s t r i b u t i o n of t h e r a p i s t s  United  concluded  that  was e v i d e n t . given  States, a  Langwell,  Wilson,  and  geographic m a l d i s t r i b u t i o n  They found that the  geographic region  numbers  of  therapists  setting,  study  revealed  (0-5) were i n r u r a l  areas;  a  participation  number in  of p r o f e s s i o n a l  between  of  isolation  and  by  (1979)  her  Bennett  the  in  s e t t i n g s . She  development of and  scarcity  of  access to'experts  traditional and p o t e n t i a l  number of p a r t i c i p a n t s to support programs, and  t r a v e l r e s t r i c t i o n s imposed by geographic remoteness. The most f r e q u e n t l y  in  to  including  decreased  isolation.  geographic  barriers  programs  resources,  f a c u l t y , a small the  rural  low numbers of t h e r a p i s t s  model of program development f o r use in s e m i - r u r a l  academic  the  having  education was d e s c r i b e d  identified  size  77% of the c o u n t i e s  relationship  continuing  of  a  that  a f i n d i n g which supports the notion The  in  r e l a t e d d i r e c t l y to the p o p u l a t i o n  income. In r e l a t i o n to the nature  relatively  (1981)  i n the occupation  and per c a p i t a the  Deane  the  literature  investigating practise  in  the  s t a t e d r e s u l t of geographic  is  professional  reasons  rural  (Castleton,  Taylor,  Dickman,  opportunity  to  on  1970;  health  competent  Heald,  and  Kane,  keep  current,  consultation,  and  access  important  the  decision  to  i s o l a t i o n . Several professionals  studies do  not  areas suggest that the fear of p r o f e s s i o n a l  i s o l a t i o n and i t s e f f e c t s factor  why  remoteness  Cooper,  1973).  to  and  is  school  for or  h e a l t h care  major 1973;  identify  professional centers  where to l o c a t e . Such  suggest that the lack of supportive  a  Coleman,  Respondents  opportunity medical  of  practise  as  findings  facilities  and  27  professionals education  of  be  as  interchange  one  the  her  to  community  acknowledges offerings  exchange  of  suggests  read  remoteness  is  to  not  therapy  being  the  experience  of  she  utilize  an  major  concern.  fact  that  which  increased  were  in  rural  practitioners,  made  and  of  a more  the  develop issues  t o keep knowledge and  professional  rural  remoteness,it  appears  that  concepts rural  loans,  and  professional geographic  (1977) s u r v e y  isolation  was  in  as a m o t i v a t i n g continuing  by  the  a  the force  education  available  individual  of  not  the p h y s i c i a n s viewed  accepted  populations  own  the  of  r e s o u r c e s were not  skills  She  their  and  that  consequence  setting  in  professionals.  suggest  determined  inconvenience  rural  education  recommends t h a t  participation  many  the  professionally.  f i e l d . Ducker's  in a rural  their  rural  that  to  In h i s sample, many of  Because  more  then,  only therapist  interlibrary  inevitable  that  in  continuing  therapists  abreast  evidence  p h y s i c i a n s concluded  their  that  keep  rural  evidence  that  the h e a l t h c a r e  they  the  professional  w h i c h many t h e r a p i s t s  practise,  some  in  minimize  daily  reading m a t e r i a l with other a l l i e d  isolation  effort  the  accessible  journals,  is  to  Continuing education  to  a lonely  lack  current  There  programs.  isolation.  states  be  p r o g r a m s . In o r d e r in  attempt  of o c c u p a t i o n a l  (1978)  the  a demand f o r c o n t i n u i n g  benefit.  can  and  therapist  will  alternative  description  Devereaux  involved  that  produce  w i t h c o l l e a g u e s from  areas are unable  setting  areas  professional  seen  In  rural  opportunities  feelings can  in  effort  individual  to was  i n an  c u r r e n t . Although  there  is  are disadvantaged  because  of  in  some  cases  those  28  professionals education urban  in  the  outlying  p r o g r a m s and  are  areas  more s a t i s f i e d  "Need" continuing profile  is  can  be  obscurtiy  Archambault  traced  of  of  them  used  terms  the  sense  between an  and  (1971)  well-being  than  their  of  are  i n the  between  most  The  contributed  to  the  the  term  1961).  use  of  identification is  a  result  a desired  "real  that  high which  one.  educational  is correctable  of  a  of  a  Atwood need"  d e f i c i e n c y which d e t r a c t s  one  and  opportunities.  state  term  its  philosophy  general  s t a t e and  the  that  Komisar,  i s i n the  existing  learner;  a number of  education  or  operational educational  by  ones,  means by  literature  as  of  an  Basic  the  to  from  through  t e r m need  (1975)  needs  needs a r e  and  those  a  can  not  human needs have  a bio-psychological  state  i n common  distinguishes "educational  that  educational  implication,  experiences.  of  Knowles  process"  needs. E d u c a t i o n a l  satisfied  variants  literature.  "operational  learning"  the  the  established  the  1978;  deficient  propose  has  in adult  experience.  There  being  The  a carefully  learning  (Griffith,  educational  discrepancy Ellis  however,  that  state.  educational  educational  term  deficient  (1966) s t a t e s  the  (1977) s t a t e s  i n the  describe  to  i t s meaning  Monette  in  by  continuing  Needs  most commonly  learner-centered  popularilty  "need"  among the  education.  emphasizes  use  more  colleagues.  Learning  the  attend  are  capable  experience be  met  been similar  or of  while through  described to  drive  29  which  initiates  a motive  in  task  program  and  A and  by  expert.  The  the  based  and  between  comparison  or  (1977) and only  a  when  Ellis,  that  interests  evaluation term  or  need by  the  to  used  estimation  to and  individual. in  specific  (1978)  and  opinion  " g e n u i n e need"  continuing objectives,  identifies  n o r m a t i v e need as  the  it  the  self-perceived  of a d e f i c i e n c y  concept  is  Popiel  basis  and  states  based  a  on  are  felt,  (1968) i s t h a t some e d u c a t o r s b e l i e v e  programs  needs  between  to  educational  felt  term  need a c c o r d i n g  enter  that  educator's the  (1974)  frequently  thereby providing  better  human  standard.  learners  needs a r e  of  Koonz  surrounding  discrepancy.  the  by  wants, and  relative  and  need  learner,  the  literature  Bradshaw  is also  objective  Knox  to  replaced  objective  a need  felt  t o an  issue  reduce the  that  relevant  basic  planning.  definition  t o a minimum  key  potential  be  obligations.  wants compared  is  "need"  the  (Kendler,  o b j e c t i v e l y demonstrable d e f i c i e n c y  implies  difference  need  on  "prescribed"  or  Monette  not  individual  that  (1966) u s e s t h e  subjective  adjective  The  are  needs.  Archaubault  standards,  on  however,  needs d e n o t e d an  a need  education  the  synonomous w i t h d e s i r e s ,  normative  discounts  of  i s made i n t h e  educational  that  describe  part  t o program  major d i s t i n c t i o n  needs a r e  an  that  in reference  normative  felt  planning  suggests  "motivation"  the  (1977) a r g u e s ,  1961). M o n e t t e needs  on  of  197-1; Bradshaw,  motivation  (1977) s t a t e s  need  recognized not  recognized  programs  felt  of  by  a valid 1974.)  as  s u c h by  to c l o s e that  voluntarily,  since  source  of  gap  adult  selecting  i s e s s e n t i a l . Others objective  the  the  contend  individuals  information  and  (Atwood  30  T h e s e two u s e s of t h e t e r m need of  who  can  best  professionals. need  not  Bradshaw  i n health  limited  by  care  the  the  health  are t y p i c a l l y  perception  needs  care  effects  individual (1967)  these  health  relation  to  defines  of  because  needs  (1978) s t a t e s  global  Popiel  i n order  that  motivation  investigated felt  development that  vs  are quickly  apparent  t o e v e r y o n e , needs t h a t  and  future  between terms  needs.  needs  practising  Chatham  identified  normative  needs  nurses.  must  She  by  an  She  exist  b u t may n o t be  defines  and  a r e needed by t h e s t a f f  queries  the b a s i s  focuses  level  needs  judgement  t o best  of competence.  as  needs  apparent,  on t h e d i f f e r e n c e s  normative  g r o u p of s u p e r v i s o r s '  felt  considering  committee  a s s e s s m e n t and f e l t  or  some p r e - d e t e r m i n e d  become  between  supervisor's knowledge  have a l e a d e r s h i p  needs  advisory  programs.  important.  move  (1979)  in  are  programs  Programs  needs  felt  education  needs.  by t h e  as m e e t i n g  states  present  Price  filled  needs  normative or future  recognized  education  normative  in helping  by t h e  and  normative  of c o n t i n u i n g  function  real  i s created.  needs but a d v o c a t e s t h a t continuing  that  far-reaching  (1977)  needs a r e b e s t  the programs  that  and  that  the  therefore  may n o t be p e r c e i v e d  practitioner.  are  i n the d e l i v e r y of  however,  (1981)  health  they  and may  by c h a n g e s the  of  a s s e s s m e n t s of f e l t  inadequate  generated  changes,  learner  Smallgren  that  n e e d s . Koonz  of the i s s u e  needs  of the i n d i v i d u a l  because  care  maintain,  potential  are  and t h a t  of  learning  (1974) a s s e r t s  be i n d i c a t o r s o f v a l i d  educational  She  assess  form t h e b a s i s  which  she  i d e n t i f i e d by  need  as  o f what  perform  the skills  the job a t  In h e r c o n c l u s i o n s  she  upon w h i c h t h e n o r m a t i v e a s s e s s m e n t s a r e made  31  but  she does It  one  not a d d r e s s t h i s  is interesting  reviewed  which  to note that attempted  differences  in learning  supervisor's  would  to  practise  clinical  needs  b a s e d on a  other  words,  being  achieved  question  to  of  felt  in  o c c u r . She  process-oriented  need  areas  where  would  learning  supported  h y p o t h e s i s but  which  needs  in  relation  was  t h e r e was  indicate  information.  identify would  how  In  goals  emphasize  were  what  required.  was  only areas  t h e m s e l v e s would  assessment  b e i n g done as  the  hypothesized that  factually-oriented  normative assessment  this  predict  while c l i n i c i a n s  lack  and  Chatham's s t u d y was  need would  identify  i n her study.  The  no d i s c u s s i o n  was data  of  why  these d i f f e r e n c e s occured.  Needs  Assessment A  the  fundamental  principle  i m p o r t a n c e o f c o n d u c t i n g a needs  and  implementing  technical  process  functional basic  premise  identified that  is  a  program.  wherein  requirements  participant  behind is  an are  the  unlikely  between p r e s e n t deemend  (Popiel,  1977).  including  inappropriate  lack  The  of a s p e c i f i c  Needs  individual's  of  change  performance  and  be d e f i n e d  then conducted t o . i d e n t i f y  or c o m p e t e n c e .  a  states  the  that  a  gap  is  is  changed  personnel assignment,  skill  (1975)  unless  and  to  organization's  t h e program  identification  planning  refers  need  much  Logically  p r o b l e m may  or  Knox  concerns  before  assessment  identified.  to  education  assessment  assessment  desirable.  p r o c e s s begins with problem  or  of c o n t i n u i n g  needs  a  performance development assessment  i n a number of ways low  staff  morale,  Needs a s s e s s m e n t s a r e  ways i n w h i c h p r o b l e m s  can be  reduced  32  through c o n t i n u i n g Nowlen are  (1980)  states  threefold. Firstly,  basis  for  limited a  education  list  that  of p o t e n t i a l  further  use  is  funding  requests. may  learner  provide  needed  and  the b e n e f i t s needs  programs.  assessment  areas  document In  create  a lack  in  order  (1972)  maintains notion  than  they  know;  notion  in  program  policy  educational programs  a the  yield  priority.  A  to support  without  of c o n t i n u i t y  a  that  a  needs  f o r the i n d i v i d u a l  a t the e x p e n s e  that  of  much  He  advocates  need as a method of p r e v e n t i n g  carrried  out  general  consensus  i n the l i t e r a t u r e  task,  (Quastel,  typically  i s t o be a d e q u a t e , and assessment  the  (1980)  used t o d e s c r i b e  Note  in adult  of  that  needs  professionals  assessment  in  is  to carry  the  health  a  out a  planner. assessment  These c a t e g o r i e s  assessment  is  procedure i f  methods of needs  education.  education  needs  5 ) . T h e r e a p p e a r s t o be a  t h e v a r i e t y o f needs  on c o n t i n u i n g  of  rationale.  the time n e c e s s a r y  four  of  the p r o l i f e r a t i o n  p r o h i b i t i v e t o the program  identifies  more  diagnosis  i n v o l v i n g more t h a n one  that  i s often  a r e commonly used  literature  learn  t h e w i d e s p r e a d a c c e p t a n c e of t h e p r i n c i p l e of  rarely  Knox  to  labour  f o s t e r s t h e "more i s b e t t e r "  a s s e s s m e n t , a c o m p r e h e n s i v e needs a n a l y s i s  complicated  planners  e v e r y o n e ought  which  planning.  some program  w i t h m i n i m a l or no u n d e r l y i n g  Despite  be  of  in order  planning  i r r e l e v a n t programs  the g e n e r a l i z e d  that  provides  In a d d i t i o n , c o n s i d e r i n g  e x i s t i n g need  addition,  under  proper  assessment  opportunities.  Houle  it  of needs  a r e a v a i l a b l e , needs a s s e s s m e n t can  program  to  assessment  that  adequate  more r e l e v a n t  resources  efforts.  will  found i n the care  field.  33  Comprehensive presented  by  descriptions Lorig  however, o n l y The  is  of  used  to  form t h a t  interested  i n the  evaluations  are  clinicians  who  a  i s most  often  likely used  o f f e r e d , one  "trial  and  error"  therapy  would  considering  the  are  asked  about in  Price, this  method  indicate  the  this  Smallgren, be  an  method  of  of  the  r e a c t i o n or  they  of  would  the  sources  to plan in  relatively  commom  their felt  or  educational  1973; and  need.  by  form  and  Nowlen is  the  respondents  used  in l e a r n i n g needs  extensively  McGregor, Note  interest  a  offered.  perceived  Long  of  on  risky  interest  Although  because  This  occupational  t o p i c s to which  area.  of  where a l a r g e number  most  taps  workshop  programs.  of programs t h a t  of  be  needs  procedure described  of  and  program  end a  similar  method  1981), H i e m s t r a  of  sample  resources  (Hightower,  inadequate  existence  the  The  extent  offering  (1981) s t a t e s t h a t  number  subject  reviewed  (1976),  numbers  the  which  program  assessment  p r o g r a m or  to  The  a list  i n d i c a t e the  literature 1977;  in  setting  limited  at  indication  which has  of  a  complete  i n the  inventory.  each t o p i c . T h i s  the  to  of a s s e s s m e n t  composed  to  a specific  in  type  interest  questionnaire  survey  are  here.  the  offering  attend  consider  the  included  to  basis.  likely  second  asked  accurate  programs a r e  The  a  f u t u r e . Smallgren  are  Collart  a p o t e n t i a l m a r k e t . One  for t o p i c s  fairly  and  evaluating  a p p r o a c h of  are  asks  be  techniques  p r o c e d u r e c o n s i s t s of  i s to conduct  participants  evaluation  is  will  then  estimate  technique  program;  costly  (1978),  most p r e v a l e n t  p a r t i c i p a n t s . The  this  method  Bell  o p p o r t u n i t i e s and  often  using  assessment  most common a s s e s s s m e n t  educational types  the  (1977),  of  5;  (1974)  found  d o e s not  always  34  A third experts  type  familiar  estimate  their  assessments of  (1967)  support  for  demands. In  their  accreditation  audit  for  relation  problems  disciplines.  including: review  He  s t u d i e s , and  occuring  employers  along  with  evaluation  data  and  one  of  to  Lessinger  as  in identifying  can  be  addressed  Johnson  and  in  Ware  physiotherapy opportunity  prepare  of  level  for  a  on  number  need  in  around  professions of  data  recidivism rates,  surveys.  with  needs  actual the  job  the  p r e c i s e gaps  review.  performance  p u r p o s e of  between c u r r e n t  Popiel  assessment  performance  improvements,  through t r a i n i n g .  of  sources  rates,  (1974) d e s c r i b e s the  care  chart  system  programs  most e f f e c t i v e  gap  or  assessing  of  describe  the  statistical  new  health  be  Normative  of  a  of  future  i n c i d e n t notes,  satisfaction the  need.  analysis  specific  employees  competence. important  committee  organizing  in conjunction  identify  needs  present  proposes  mortality  d e s i r e d c h a n g e s and being  and  of  and  than  patient  to  advisory  their  based  suggests  Nowlen d e s c r i b e s  Both  form  planning  and  learners  providing  diagnosis  (1981)  rather  morbidity  p r o c e d u r e s as  the  Walsh  on  p o t e n t i a l p a r t i c i p a n t s need not  the  education  an  as  depends  normative  field.  anticipate  in  to patient care  clinical  by  reports, c r i t i c a l  example.  continuing  out  maintain  estimation,  a l s o take  These  educator  to  to  potential  normative assessment  only  also  procedure  of  needs.  the  directly may  group  particular  of  of  not  but  or  use  role  competency  data,  the  i n the  the  the  represented  assessment  frequently carried  collegues  assessment  with  experts  describe  needs  educational  are  made up  and  of  and  the  desired  use  of  job a n a l y s i s  in  knowledge  (1977) a l s o  that  describes  35  the  use  of  useful  performance e v a l u a t i o n s  procedure  Another Nowlen  method  i s the  of  the  the  health  support  results  field,  the  of  investigations,  types  of  liberal  include,  or  physio  need of  disabled  particularily  mentioned  by  i s working.  In  of  of  f o r example,  children  for  example.  studies i n the  or  reporting health  care  i s i m p r a c t i c a l . A number that  i n d i c a t e d on  clinically  assessments  of  oriented  than  other  human r e l a t i o n s , a d m i n i s t r a t i v e , (1973)  and  continuing  a  representitives  burn p a t i e n t s  diversity  Hightower  that  as  represent i t i v e s  professional  information  s u c h as  field  not  of  needs assessments  more f r e q u e n t l y  orientation,  the  however, have c o n c l u d e d  studies.  greatest  the  use  consisting  p a r e n t s of  programs,  concluded  stroke  learning  common  may  number and  a summary of  programs a r e  in  these  groups,  clients,  B e c a u s e of the  is  committee  field  nursing  t r a i n i n g needs.  group with which  care  a d v o c a t e s of  that  planning  client  patient  in determining  i n the  and  McGregor  occupational  education the  (Note  therapists  programs w i t h  areas  of  or 5)  are  a  in  clinical  neurophysiology  and  orthopaedics. Cafferata distinguish needs need that  (1975),  between  identified  of  (1971),  nurses. These  treatment  best  meet  basic  skills  the  that  three  based  planners  needs of  information. in  in  clinical Although  perceptions  and  Chatham  process orientations studies  programs  administrative/management  (1967) c o n c l u d e d  differences  f a c t u a l and by  for p r a c t i c a l  Ferguson  were  oriented continuing  n u r s e s by these  (1979)  in  found  learning that  higher  the than  programs.  Price  education  would  o f f e r i n g programs  studies  on  referring  to  have more l i m i t e d i m p l i c a t i o n s  for  36  planners  of  because  of  programs the  specific  i l l u s t r a t e that attempted  to  occupational  in occupational nature  differences identify  in  of  the  must  be  (1981)  most  needs  who  of  states fail  that  participants  that  that  the  seriously  to  these  potential  participation as  important  barriers,  programs  a number of  same  most  the  barriers  upon t h e  and  way  respondents  to  that may  "need"  the can  minimize  the  useful  in  respondent's a b i l i t y  some  a  or  non-  process. in  the  thereby  barriers  to  interviews  or  broad  coverage  identifying different  to  method, however,  analyze  d e f i n i t i o n s of  investigator  identify  being  subgroups. This  the  Cross  program.  used  interpret  out  by  barriers  frequently  are  carry  assist  identifying  and  education  planning  methods f o r  for various population  dependent  attendance.  identified  then,  which  a c c e s s i b i l i t y of  to  impact  participants;  Survey q u e s t i o n n a i r e s p r o v i d e  potential  relative  p e o p l e who  questionnaires.  behavior  of  programs,  limit  the  is  field  education  assess  i t i s the  equally  of the  continuing  participation,  barriers  the  study  Participation  which c o n s i d e r  of  There are  of  they  This  to p a r t i c i p a t e . T y p i c a l l y planners  are  development increasing  in  nursing  used,  exist.  differences  to a c c u r a t e l y  barriers  Identification  to  factors  assessments  maintains  of  samples  perception  provide  able  a wide v a r i e t y  Cross  the  than  therapy.  effectively  planners  of  similar  Barriers  To  therapy  their  barriers  does.  In  addition,  all  of  the  in  own the  survey  barriers  as  37  pertinent  to  them and  information  has  questionnaire interview and  the  to  one  number  of  location  are  in that  i s by  where  of  the  for  both  and  t h i r d method of  of  identifying levels  (1981) c i t e s a  varying  to  the  often  participation  relation  the  clarification  barriers  effects  the  procedures,  i s modified. Cross  in  used,  Although  i t allows  observing  the  considered  not  time consuming  a program  examples  is  value.  information. A  participation aspect  of  are  definitions  more d e t a i l e d  barriers when  interview  of  system  practical  advantageous  validation  yields  ranking  limited  and  is  if a  cost  decreasing  and these  barriers. The that  major d i f f i c u l t y  studies  tend  participants eliminated barriers  in from  are  perception  them,  data  this  Cross by  adult  based  most  thus  those  arise  professional  a  rural with a  for  responsibilities.  area family,  the  The  barriers  derived  from  non-respondents  individuals  addition, upon  is  the  the  for  whom  respondent's  method  to  compare and  of  barriers  used  to  validate  variable. types  institutional,  situational  time. Transportation in  In  it difficult  situational,  that  the  i s dependent  making  describes  information  are  (1981) i d e n t i f i e s t h r e e  and  barrier  on  relevant.  program p l a n n i n g  She  those  i d e n t i f i c a t i o n of  education.  studies  barriers  barriers.  given  these  learners:  are  be  the  continuing  the  of  assess on  to  with  as  the  and  most  a  or  lack  and  the  Institutional  in l i f e  situational of  insufficent  individual  dispositional  prevalent  from one's s i t u a t i o n  would be  with  barriers  heavy are  type at  barrier  child time  experienced  a  care  any for  for  a  situational professional  those p r a c t i s e s  and  38  procedures which participating  exclude  in  or  educational  p r o g r a m c h a r a c t e r i s t i c s and personal  and  barriers  of  vocational  this  information category  about  from  relation  to  (1974)  schedule,  admission  increased. and  revealed  lack  learning,  barriers  of  and  are  unacceptable  organizing  to  time.  it  barrier  but  category  in  three  should and  be may  types noted  of of  that  and  barriers  are  barriers  over  as  fitting  the  willingness  to  pay  ability  willing  to  pay  t h a n one  more t u i t i o n that  is  based  cases  and an  as  a  viewed  some  examples  that  these  useful  in  learners  many b a r r i e r s f i t i n t o more  change c a t e g o r i e s  In  was  attitudes  that  i t could  considerations.  as  type.  identified  that  factors  professionally  i s commonly  be  and  dispositional  Cross suggests  socially  types  in  succeed, d i s i n t e r e s t  Although  this  or  participation  f o r example,  separate  career  is  such  This  Ruyle  r e l a t e d to  to  energy.  b a r r i e r s of  numerous  category  Cost  in a b i l i t y  it  of  existing  a l e a r n e r . Common  identified,  because  these  those  of  by  changing  as  lack  viewpoint  study  location,  oneself  confidence  identify  the  identify,  about  least often  Although  one  by  and  insufficient  underestimated  than  that  A  to  identified  s u i t a b l e programs.  participant's  a whole.  policy,  self-perceptions  are  as  related  location,  irrelevance  D i s p o s i t i o n a l b a r r i e r s are  include: in  of  from  individual's  most commonly  perceived  profession  the  poor  lack  individual  Geiselman  The  adults  These a r e  f i t with  scheduling,  p r o g r a m s , and  the  the  they  sitution.  include  working  activities.  how  type a r e :  would a l s o  programs  discourage  on  of  a situational dispositional t o pay  individual  f o r a program t h a t soley  period  may  advances  personal  are be their  interests.  39  Likewise, an  job  responsibilty  individual's  situation  unreasonable  or  institutional  barrier.  The  Cost,  overall. Broski  and  were  by  a  pharmacists,  studies  that  these  of  therapists,  barrier. A  (1978) p o s e d  the  question  responsibility perception  of  as the  suggested  participant's  study  a  that  of  adult  and  job  barriers  are  professionals  the  A l l of  and  the  Benell  statement on  employer's e v a l u a t i o n in  commonly  responsibilities  the  employer's  responsibility  and  including  physicians.  based  their  (1979),  four  whether was  barriers  Gardener  related  of  related  (1969),  job  an  learners.  Greenberg, Edelstei'n,  barrier  the  level  by  or  number  Evanson  and  to  of  situation  a  as  and  health  r e v i e w e d made r e f e r e n c e  a major  was  Rodowskas  number  of  with  classed  identified  Connelly,  from  programs  i t would be  frequently  Seymour,  suggest  of  arises  r e s p o n s i b i l i t y , and  most  (1979),  (1969)  nurses,  case  (1981) r e v i e w  family  the by  Upps  experienced  the  frequently  literature reflects  Cross's  travel,  Studies  Wechler  as  to  to  responsibility  in  education  similar  distance  but  a barrier  i n f l e x i b l e schedules,  continuing  findings  as  of  job  employees'  perception. of  the  relation  It  potential to  being  0 absent  from  p r o g r a m may study  be  by  what  Peterson  perception of  work  of  health  in  order  is  reflected  barriers  to  of  and  in  although  professionals,  p r o g r a m p l a n n e r s . The perceptions  attend  (1975) a d d r e s s e s  barriers  care  to  the  investigation  what p e o p l e  continuing  a continuing  job-related the  the  issue  sample was  findings  are  barriers.  A  differences  in  not of  to  composed  interest  compares community  i n t h e i r community  education  of  education  to  leader's  would p e r c e i v e  s e l f - p e r c e p t ions  as of  40  inhabitants  of  assigned  the  and  importance  residents, way  example,  some  to  type  Participants  for  whom  as  are  the  a  t o p i c s that  f e a r of  p r o b l e m would  planners  decisions  returning  b a r r i e r s by  supports  than  implications  base p l a n n i n g  inconvenient  were r e v i e w e d  a  occupational  programs.  into  to  on  study  introducing the  program.  scheduling  or  likely  against  react  family  identified  lack  family  contributing  32%  who of  stated  their  5)  the  needs were not  and  as  lack to  through  the  of  (1979)  with  inconvenient  49%  the  of that  existing being  met,  major  barrier  financial  support  participate  by  the  stated  their  r e s u l t s were r e p o r t e d of  that  met  inability  addition  found  to  occupational  being  Similar  the  and  physiotherapists  s u i t a b l e courses  responsibilty to  (Note of  needs were not  those  related specifically  i n c l u d i n g both physio  t h e r a p i s t s and  Of  that  sample. McGregor  educational  with  and  leaders  barriers  interesting  esteem o r  psychological  rehabilitation,  therapists  73%  might  of  studies  of  their  with  that  assumptions.  Two area  dispositional  presented  self  f i n d i n g was  overcome t h e s e p e r c e i v e d  responsibilities planners'  to  leaders  p a r t i c i p a n t s ' low attempt  major  a conclusion  programs a r e  d e v e l o p . For the  community. The  higher  community for  the  Seymour, C o n n e l l y ,  in  programs.  and  scheduling  Gardener  as  a major  study  which  barrier. The  literature  represented  a  major  above. Smorynski professionals  and  review  revealed  disagreement Panocha's  suggested  that  to p a r t i c i p a t i o n in continuing  only  with  the  (1979) s u r v e y cost  was  not  education.  one  findings of  described  allied  health  a significant  barrier  Although  location  and  41  lack  of  attend  time  a continuing  factors  number  program  to  concluded  that  notice  of  included  continuing  continuing  course  opportunities notice  Edelstein, the  areas.  increasing and B e n e l l  week,  time  Bennett  location  is  of geographic  4 ) . The t e r m  states  a means of making  is  t o determine  to  advance  Nurses a r e r e l u c t a n t t o  available  when  costs  of  p r o h i b i t i t s i n c l u s i o n i n the  that  barriers  as  a  by G r e e n b e r g ,  t o f a c t o r s such as  day  in outlying  decentralizing  program  Systems  a s a means o f making  to the p o t e n t i a l l e a r n e r  an a c t i v i t y  provide  tasks  participants  remoteness.  intended  major  (1969)  t h e most e f f e c t i v e means o f m i n i m i z i n g t h e  person  the  to  decrease  of Nurses  o f day , and o f f e r i n g p r o g r a m s  accessible implies  help  p r o g r a m s when l i t t l e  (1978) i n r e l a t i o n  systems a r e d e f i n e d  opportunities  Survey  of i n s t i t u t i o n a l  Delivery  Delivery  to  p a r t i c i p a t i o n was s u g g e s t e d  (1979)  likely  process.  potential  i s given.  last  recommendations f o r  education  education  c o u r s e s on s h o r t  of  was one o f t h e  specific  for  offerings  of  i n the d e c i s i o n t o  i n the decision-making  b u d g e t . The m o d i f i c a t i o n  method  barrier  program, c o s t  i t is difficult  advantage  attending  of  in  considerations  p a r t i c i p a t i o n . The O n t a r i o  to attend  agency  education  of s t u d i e s  planners  barriers  take  important  t o be c o n s i d e r e d  A  plan  were  create  on  the  opportunities  those o p p o r t u n i t i e s  of t h e program p l a n n e r  t h e most  part  relevant  of  (Gobert, a  Note  resource  f o r l e a r n i n g and t o a v a i l a b l e . One  in continuing  delivery  learning  system  of  education considering  42  the  potential  Within  in connection with d e l i v e r y  method,  and  with'the  term  this  delivery  the  s y s t e m s as  s y s t e m s can  of  ways.  a number systems  of  content.  terms  including: less  i t applies  major  type  be  have  format,-  interchangable  to program p l a n n i n g  can  of  media  used.  One  to typologies i s Verner's of  described:  method, t e c h n i q u e ,  classified  adult  difficult Gobert  home s t u d y ,  the  is  to  areas  o n l y . In t h e  seminars,  three  typically  the n a t u r e  relevant  describe  as  types  and  correspondence  delivery present  of  short  systems study,  direct a  courses  Verner  has  education  with  delivery or  it  another. systems:  instructional-  of it  designed  system  and  Although  nature  systems  direct  are  of d e l i v e r y  initiated. the  elements  adult  system  in o c c u p a t i o n a l therapy,  either  Examples  to  the  mixes the terms  of one  or  of  Although  presenting  community  education  used  systems.  which  4) d e s c r i b e s f i v e  and  t h e number of  t h e most f r e q u e n t l y  o f f - c a m p u s c o u r s e s , mass-media b a s e d ,  classification  considered  on  in  participation,  of  device.  for  literature  (Note  based  together  (1962) c l a s s i f i c a t i o n  in  and  forms  t o compare  based,  continuing  education  numerous  opportunities,  be  t h e amount of a u d i e n c e  processes  media  c a t e g o r i z e d or g r o u p e d  Typologies  in attendance,  referred  is  program  study.  number  people  and  medium a l l of w h i c h a r e more or  Delivery a  objectives  t h e program p l a n n i n g l i t e r a t u r e  been u s e d  in  participants,  the  study  was  distance  include:  of  primarily  f o r use systems  this  in  rural  will  delivery workshops,  w h i l e d i s t a n c e systems a p p l i e s  courses, educational televison,  and  be  audiotapes.  to  43  Di r e c t  Delivery  A  review  system  by  professional  the  f a r the  education  in  resource each  of t h e l i t e r a t u r e  is  'element  Systems  these  other.  i n the  face  that  commonly  health  is  care  that  to face  example  symposiums,  of  seminars,  in  field.  the  and  ^the  the d i r e c t used  type  interact  of  continuing The  common  participant  V a r i a t i o n s of the t r a d i t i o n a l  most common  lectures,  most  systems  p e r s o n meet  reveals  and the  directly  with  workshop s y s t e m s a r e  direct  system  and  include:  and s i n g l e day b r a i n  storming  sessions. Direct the  one  d e l i v e r y systems may be c o n t i n u o u s  or  two day workshop, o r i n t e r m i t t e n t , w h i c h  s y s t e m s where t h e r e parts  as  occurs  more common often  i n the  learning  Hiss  (1976)  education  based  these  planning A  two  is  day  other  work  health  describes  the formal that  approach  third  Grand  or  tasks  describes program  programs  f o r the p a r t i c i p a n t s to parts  in  order  to  1973). two d i r e c t initiating  program  approaches to c o n t i n u i n g t h e p r o g r a m . The  organized  on a c l i n i c a l  rounds,  direct  t h e work  speciality  i s a common example  describes  staff  setting.  sponsored  of t h i s  programs t h a t  visiting  first  by a c o - o r d i n a t o r or  i s not connected with  of  in  systems a r e  Intermittent  program  a r e examples o f t h i s type  The c o n t i n u o u s  field.  between  organization  presentations  care  (Nakamoto,  as  a one day b r e a k between  courses.  projects  workshop  setting.  A  short  on t h e agency  committee  professional The  in  i n the i n t e r v a l  reinforce  of  i s at l e a s t  incorporate  complete  i n nature,  by t h e  approach.  occur  lecturers,  i n the  or  case  format.  delivery  system  that  can  be  44  described  i n terms of  systems  more  (Note 4)  prevalent  sciences  than  interest  groups  are  the  best  Distance  in  distance learner  and  and  the  which  resource  physical  as:  influence  of  materials,  of  learning  necessary  in  or  is  most  2)  commonly  uses  health Special  they  conduct  system.  form of  out  the  that  cited  reviewed  employment  and  barriers  that  suggest  principles  of  s t u d y where  the  essential  learning  Keegan  (1980)  a distance  delivery  resource  person,  and  in planning and  the  of  learning  potential  for  system. distance  delivery  opportunities  from  systems  f o r study  i t f o r whatever  Although  reason  barriers  for to  location  implementing  distance  participation  responsibilities  to the  planner  or  geographic  d e l i v e r y systems.  family  to  reason,  remoteness, p h y s i c a l d i s a b i l i t y ,  necessity.  of  of  student  media,  debarred  for distance  could  upon the  a  to provide  geographic  vocational  based  a direct  states  are  systems, c o n s i d e r a t i o n alternate  delivery  organization  using  order  i n d i v i d u a l s who poverty,  the  education.  from e a c h o t h e r .  of  technical  (Note  the  of  in  programs t h a t  characteristics  separation  Brookfield  domestic  apart  educational  use  systems  person c a r r y  general  an  supplementary  it  type  learner-initiated  describe  responsibilities  system  be  this  those  learning  adult  formalized  are own  education  of  d e l i v e r y systems are  the  those  areas  program  t o meet t h e i r  continuing  the  education and  initiate  the  Systems  describes  are  in other  Delivery  of  comments t h a t  example of  Distance  tasks  initiater  which p r o f e s s i o n a l s  needs. Gobert are  the  that  In  the  were  reveals  literature two  distance  major systems  45  may  be  appropriate  (Bennett,  1979,  therapists,  Cross,  or  continuing  most  then,  point  view of  should  i s prevented  materials are  c a s e where s t u d e n t The  resource  the  learner  with  a  and  to  common examples of  The  indirect  employed  interaction or of  the  to that  resource  the  educational cassettes.  are  systems.  Distance  rather  replace be  the  used,  the  in  a  physical  case  the  the  simulation  the  or  approach.  where  libraries  i n t o the  material  in a direct  as  The  in  the  are  used.  to  permit  they  would  d e l i v e r y s y s t e m . The  materials  of  prepared  material  just  use  indirect  g r o u p s i t u a t i o n s or  s u c h as  is built  approach  most  are  the  programmmed i n s t r u c t i o n . approach  face  to  initiated approach  network,  television,  approaches to  indirect  simulation  MeKenzie,  attending  e x c l u s i v e l y from  commonly  indirect  p a r t i c i p a n t . This  communication  from  could  reason.  basic  centers  role  person  can  employment  organizations  remoteness,  the  in independent  c o r r e s p o n d e n c e program and  are  two  the  i n t e r a c t with  resource  of  ones  occupational  potential participant's actual  regardless  person's  rural  heavy  direct  approach d e s c r i b e s  used  as  of  therapist  geographic  (1977) i d e n t i f i e s  approach  materials  shifts,  considered  d e l i v e r y systems t h a t  materials  well  case  professional  be  overcoming  presence  indirect  to  not  s e n s e where the  distance  the  programs b a s e d on  broader  Wagner  In  well-intentioned  education  systems  a r e a s as  irregular  commitments  the  of  1981).  working  schedules, prevent  in metropolitan  the  radio,  Postgate,  i s used where  face by  interaction  e i t h e r the  involves most audio and  techniques  the  common  resource  use  of  an  person  some  examples  cassettes  Scrupham  with  and  (1975) s t a t e  type being video that  46  the  r a p i d growth of these  systems  has  made  systems a c c e s s i b l e t o t h e program p l a n n e r  Systems i n Cont i n u i n g Research education  in  area  gather  one  o r two i t e m s . i n c l u d e d  of  continuing  short The  courses,  first  other far is  two  care  92%  tendency only  in length  workshops  i n favor of  Studies  of the  to bias  (Note  derived  from  on  the  topic  field,  five  major  identified  by  Nakamoto  i n t e r m i t t e n t systems o r broadcasting.  systems  while  the  s y s t e m s . She s t a t e s t h a t by i n the h e a l t h  care  field  t o be u n i v e r s a l l y f a v o r e d by  while  of  by  presenting  Broski  t o other  workshops  5) s u g g e s t  comparison  used  the response  toward d i r e c t  r e m a i n d e r . Of t h o s e  or  five  studies  in  to  instruments  four  that  these  that  workshops,  from  included  62% -  alternatives, studies  systems.  a  reveals a Frequently  systems a r e i n c l u d e d  of t h e d i r e c t  (1979),  the s t a t i s t i c s  d e l i v e r y systems range  in  continung  a n d Upps  are p r e f e r r e d . Although  one o r two examples o f d i s t a n c e  survey,  care  direct  p r o f e s s i o n a l s a s a method  o r two d a y s  review  and s e m i n a r s a p p e a r  ( 1 9 7 3 ) , and McGregor  comparing  survey  attempt  type.  opportunities.  Hightower  which  home s t u d y , and  of these . r e p r e s e n t  Workshops  one  use have been  p r e f e r r e d d e l i v e r y system  the d i r e c t  education  In t h e h e a l t h  courses,  i n continuing  i s typically  a general  a r e examples o f d i s t a n c e  t h e most  health  Data  of s t u d i e s  systems or workshops,  circuit  three  number  within  i n common  (1973): c o n t i n u o u s  f o r general use.  d e l i v e r y systems  information.  education.  systems  of  to a small  to  delivery  baseline  delivery  Educat ion  the  i s limited  distance  i n the  s y s t e m s make up t h e  a fair  representation  47  of  distance  distance  systems,  systems.  (1979) s u g g e s t e d study  and  Edelstein, another  that  by  of  Benell  it  was  nurses  found  that  A  study  concluded  that  continuing radio,  and  distance  the  the  three  medical recorded  reported  California  educators  s u c h as  medical despite  The  study  specific education  use was  publicity  a delivery  efffectiveness weighed  broadcasting  programs.  mass medium,  may  Hunter  than  be other  (1968)  Ramsay  s y s t e m has  spread  is  variable,  against  less  audience  cost  delivery  the  were  (1969) used  by  s t a t e were  television,  concluded  that  courses.  least  field  cost  i s small,  effective  surveyed. of  continuing  stated  He  s i z e of of  same means  that  widespread  slowly. the  This  popular  doctors  and  these  supplementary  (1967) who  varied  the  systems.  that  i n the  its  I f the  and  by  was  Association  short the  studied  this particular  u s e r s as  sample of  televison  regarding  that  productive  t o the  reviewed  as  a u d i e n c e must be  their  workshops and  of  television its  by  c o r r e s p o n d e n c e was  d e l i v e r i n g information The  that  nurses  from  non-involvement  In  delivery  systems  in  Greenberg,  which  Medical  distance  material.  that  of  home  systems  of  interaction  s y s t e m s were p e r c e i v e d  to d i r e c t systems  necessary.  in preference  by  systems.  sample  Gardener  favor  delivery  the  preferred  and  surveyed  p r o g r a m s b a s e d on  personal  factor  respondents  Seymour, C o n n e l l y ,  examined  education  the  of  broadcasting  (1978) and  20%  the  preferred  continuing  discriminating  of  21%  and  t h o s e where p a r t i c i p a t i o n was  study,  study  7%  survey  perspective  preferred over  A  20% and  between  use,  suggests the  target  producing  and  television,  a  and  educationally  Gill  (1968) s u g g e s t  systems.  Vaillantcourt  and  48  five  r e a s o n s why  continuing  education  importance  they  existence content,  educational  of  versatility  program p l a n n e r s production  The radio «  and  satellites  a  receives  The  use  introduced  waves  has  professionals  where t h e  cable  educational  their  one  point  the  and  in  to  a  of  had  (1973) which  retransmits  refinement  made  and  of less  television  t h u s o f more p r a c t i c a l  in  has  recently  British  colleges  individual  transmission. the  use  of  use  1975).  satellite  enjoy  of  a major  device  simpler  has  (Dahl,  on  s y s t e m . The  be  delivery  e a r t h and  use  community  Columbia  to  technical  which home At  b e n e f i t s of the  been  Columbia.  (KNOW) i s a v a i l a b l e t o h e a l t h  stations receive  television  as  on  which  education  West  of  attractive  manner has  satellite  i n some c a s e s  British  depth  d e l i v e r y systems. Polycn  professionals  the  of  .reach  a l t e r n a t i v e t o the  a u d i e n c e and  through l o c a l or  in  a d e l i v e r y system.  broadcasting  health  the  problems  traditional  stations  direct  dish  although  as  permitted  of  receiving  of  insufficent  r e c e i v i n g s t a t i o n s . The  continuing  to  in  an  from  of  Knowledge Network of  centers  as  i n the  to a greater  field  order  e f f e c t i v e n e s s cause planners  of d i s t a n c e  receiving  accessible  In  increasingly  television  o r more o t h e r  technology  expensive  of  telecommunication  radio  them t o one  the  of  television  describes  that  education,  use  effective  programs.  in c o n t i n u i n g  use  the  time,  are  evaluation  of  not  field.  broadcasting  use  i n f l u e n c e on  in  states  i n the  and  this  insufficent  of c o n t i n u i t y of  (1973) of  h e a l t h care  is  f o r g e t t i n g t o watch t e l e v i s o n , unaware  program,  lack  Nakamoto  cautious  are:  the  and  i n the  television  KNOW  The care  have  a  televisions present, a is  62  satellite of  most  49  obvious  benefit  those  for  system  i s now  the  t o the g e o g r a p h i c a l l y i s o l a t e d  whom t r a n s p o r t a t i o n available  implementation  skills  from  factor  learning  and  activities  tapes  lectures,  Although  the  to  the  require most  effective  produce  new  crucial set  the  of  desired  limited  to d i r e c t  Another  rural  or  currently  is  the  over  experts  cities  and  program  the t r a v e l l i n g  nursing.  t e a c h e r as  Nakamoto  by D a l h o u s i e  examples o f  t h e use  each  the m e d i c a l a number o f  courses  University  are  has  in  areas  who  1964).  travelling  lecture.  pharmacy  have  of  of d i s t a n c e s y s t e m s . visited  five  of t h e u n i v e r s i t y  continuing  education  the  as  who  or s i x d i f f e r e n t done  some  pre-  concept  education  most  in  system  effective 34  s i x times per year  by  program  a c t e d as  topics.  those  involves  The or  have  general  in continuing  one  by  limited  to f i v e  who  by a  used  (1975) d e s c r i b e s a s i m i l a r  as  well  tapes.  (1973) d e s c r i b e s t h e d i s t a n c e d e l i v e r y  of w h i c h was  faculty  travel  useful  of  as  audio  (Aitken,  that  professionals Spicer  on  them  c o u r s e and  consultants  preparation.  of  systems  circuit  where  portions  a u d i o t a p e s are used  65%  system  (1969) d e s c r i b e s c i r c u i t  meet w i t h  use  non-metropolitan  Hodapp  or  for  that  delivery  t y p e of d e l i v e r y  edited  conference proceedings  reveals  professionals,  in  access  and  programmed  literature  professionals  centers  will  an  represent  symposia,  specifically  number of h e a l t h  used  of  designed  typically  panels,  as m a t e r i a l  of  system  i s the development  Although  experience.  Audio  use  delivery  or f o r  in continuing education,  the program p l a n n i n g p e r s p e c t i v e . The  i n i t s use  materials  i s a major b a r r i e r .  f o r g e n e r a l use  of t h i s  individual  A  resources for  trend  that  has  50  evolved  from  teaching  the c i r c u i t  hospitals  professional of  specially center.  The M o b i l e  deliver  continuing  Columbia  (Gobert,  programs rural  were  British  programs  described, used  Program tapes  of t h i s  s y s t e m employs a  delivery  education  in  i n the  1970).  Continuing  examples  of  in  literature.  been  i n the nursing  t h e phone w i t h o u t  field  and  in  co-operation  determining  Pearson,  Studies  programmed  a  program c o n t e n t  programs w i t h  The u t i l i t y  of t h i s  use as a supplemental the case  with  (Cooper  of pre-program learning  is  the exception  system appears  device  to other  reading  or  indicate and  Problems  that with  and H o r n b a c k , attempted  to  of pharmacy and  t o be  systems,  limited  factor  to  f o r example,  preparation.  not a s i g n i f i c a n t  Access  telecommunication  1977). Few h e a l t h p r o f e s s i o n s have  correspondence  dentistry. its  involve  been  pre-recorded  65% of t h e use i s between noon and m i d n i g h t  system  have  Dial  where  areas.  delivery  infrequently  The  charge.  m a j o r i t y of u s e r s a r e l o c a t e d i n r u r a l  use  distance  i n the h e a l t h f i e l d  the  1973;  t h e s k i l l s and  be made o f t h e more  the  learning  field.  over  service  visual  f o r updating  that  this  education  audio  of  described  over  in British  form  education  used  areas  to  health professionals in  i n the h e a l t h care  should  was  to a l l i e d  specifically  common  Center  out-lying  4; M c B a i n ,  mention  are played  assistance  used  continuing  has  with  Resource  t h e most  systems  a n d implemented  Instructionl  made a v a i l a b l e  brief  continuing  resource  available  in  ongoing  t o a c t as a t r a v e l l i n g  Columbia  Although  c e n t e r s with  o r non-  motor v e h i c l e  Note  knowledge o f t h o s e  systems  planned  A variation  equiped  i s t h e use o f community  as l e a r n i n g  education  the u n i v e r s i t y .  concept  Similarly  in continuing  51  education  in  the  instructional presented steps,  in  in a co-ordinated  sequence  of  question  s y s t e m has  been u s e d  1973). M r t e k  including  tapes,  effective  (Nakamoto,  the  recent  most  education  or  colour  education  but  have not  in delivery  of  review  related  continuing education  therapy. of  of  The  literature  v a r i a b l e s i n the  provide  relevant  f o r competent  effective  t h r e e v a r i a b l e s t h a t were r e v i e w e d needs, relation  barriers  to  to l e a r n i n g  the  to  continuing  supports  the  in  importance  occupational  process  programs in this and  to  for therapists.  The  study  were  delivery of  systems.  some  form  felt  and  normative  assessment,  as  essential  a v a r i a b l e i n program p l a n n i n g  necessity  of  major  learning  assessment,  the  two  necessary  empahasized  assessment,  the  is  was  considered  of  present, i t  assessment  not  be  of l e a r n e r s .  importance  and  found  used  t h a t c o n s i d e r a t i o n of a number  participation, need,  visual  have been  than  practise  program p l a n n i n g and  is  Literature  literature  suggests  learning  s y s t e m s . At  wide d i s t r i b u t i o n  Summary of R e l a t e d  use  l e a r n i n g i s one  f o r undergraduate t r a i n i n g the  to the  Audio  been  1973). C o m p u t e r - a s s i s t e d  b e c a u s e of  This  similar  slides  answer  i n pharmacy  system, programmed  and  self-  and  extent  that  scripts,  a  information i s  supplementary purposes.  innovations  more a p p r o p r i a t e  to a l i m i t e d  (1971) s u g g e s t s  as a d e l i v e r y  continuing medical  is  as  which  u s e f u l for remedial  kits  Defined  in  correspondence  most  field.  learning  this  approach  care  to  (Campbell, of  health  approaches  discussed.  identifying  In of to  Although  barriers  as to  52  participation barriers from  was  to p a r t i c i p a t i o n  the  field  r e v i e w e d was direct  Situational  were  defined  occupational  distance  are  and  used  the  institutional  examples  provided  The  variable  continuing  s y s t e m s as  currently  and  therapy.  s y s t e m s of d e l i v e r i n g  that  general  third  education.  Using  major c a t e g o r i e s ,  i n the  health care  field  the in  were o u t l i n e d .  The  literature  participants and  in continuing  was  therapist. existed  the  The  opportunity  for  practitioners literature  examples produced  supervisors  the  on  continung  the  rural  a  geographic  field.  need t o  to  location.  perceptions staff.  was  the  to c o n t i n u i n g  for  increase there  the were  and  the  The  second  education.  exists  rural  Although  the  occupational  clinical  discrepancy  of  of  characteristics  the  therapist  education  how  the  d i f f e r e n c e s in  their  therapists,  describing  of of  in r e l a t i o n that  characteristics  affected perceptions  role  and  in.the health care  f o r the  by  of  revealed  supported  of  education  indicated that  focussed  literature  certain  i n p r o g r a m s . One  location  characteristic  that  professional  review  between  geographic  programs  suggested  preferences  examined  The  of  s y s t e m s and  systems  needs  described.  between urban  majority  of  availability  of  few  reduce p r o f e s s i o n a l  practical isolation  53  CHAPTER THREE  METHOD  S e t t i n g of S t u d y  At  the time  opportunities were m i n i m a l . of  in  Prior  British  Education  Columbia  over  to . that  planning  was c o n d u c t e d , Columbia  T h i s was l a r g e l y  Continuing  British  the study  time  physiotherapy  and  due t o t h e a b s e n c e o f a  in Rehabilitation  the  the  had  to  been  majority  of  therapy.  the  programs  Although  g r o u p s and p r o f e s s i o n a l o r g a n i z a t i o n s had  offered  programs,  an a t t e m p t  tended  to  be  Vancouver  area.  specialty  or  resource  were n o t c o n s i s t e n t l y  to co-ordinate  these  efforts.  study  responsible for  interest  there  Director  a t t h e U n i v e r s i t y of  previous  Director  occupational  these  education  for occupational therapists  t h e two y e a r s  and i m p l e m e n t i n g  continuing  in  both  the s p e c i a l occasionally  o f f e r e d nor was These  programs  one  o r two day workshops l o c a t e d i n t h e G r e a t e r  The  typical  treatment  persons.  approach,  The g e n e r a l  described  as  rich  continuing  education.  in  program  utilizing  setting  potential  focussed  on local  f o r the study  for  program  a  clinical e x p e r t s as  then,  may be  planning  in  54  Design  As  one  of  t h e o b j e c t i v e s of t h e s t u d y  characteristics continuing survey.  a  education,  Normative  occupational contained in  of  population  the research  design  were  generated  the q u e s t i o n n a i r e . were t e s t e d u s i n g  to i n v e s t i g a t e  in  relation  continuing from  education  the  in  information  The r e l a t i o n s h i p s  a simple  to  used was a d e s c r i p t i v e  statements regarding  therapy  on  the study  particular  was  hypothesized  correlational  design.  Hypotheses  1 : There w i l l  Hypothesis percept ion clinical  clinical  would  in  expect  the  therapists  field  would than  Although  supervisors  experienced therapists immediately  to  that  learning  the  needs  base w i t h may  because  needs  different  typically  of  their  a long-term  would  This  suggest  therapists  held  by  that  up  staff  of  the  continuing supervise.  ranks  from  a  practical  broader  skills  to project their in  may more  the c l i n i c a l that  in perspective  differences  from a  supervisors  o r i e n t a t i o n while  to  number o f  supervisory  they  position,  difference  tendency  therapy,  perceptions  travel  senior  be more o r i e n t e d  relevant.  of the g r e a t e r  occupational  of the c l i n i c a l  the s u p e r v i s o r ' s staff  of  p o s i t i o n t o a more  consider  with  that  have  education  clinical  therapists'  d i f f e r e n c e i n the  t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s .  One years  of  be a s i g n i f i c a n t  are  coupled  perceptions  on  perception  of  55  learning  needs would  Hypothesis ident i f i c a t ion therapists  and  Barriers relating  field  to  career,  of  to  p a r t i c i p a t i o n between  ba r r i e r s  be  described  which  one  relate  could  often  t h e r a p i s t s may  to  therapy  and  One  continuing  a  the  clinical  longer  education  expect staff and  to  than their  to  accommodate  that  supervisory  have  thus  in  therapists  would g i v e  minimized  clinical  which  barriers  they  or  committment  supervisory  priority  time  involvement  potential  that  would  given  those  practises  institutional the  their  at  the the  b a r r i e r s would be  consider  to  of  anticipate  development.  committment  in  situational,  planning  Because  identify  situational  either  situation  to  o n e s . B e c a u s e of  professional  as  individual's  occupational  situational  barriers  of  the  more  career,  signi f icant di fferences  participation.  the  would  be  supervisory therapists.  institutional, discourage  2: T h e r e w i l l  may  to  exist.  the  identify  same  similar  participation.  Hypothesis  3:  perceptions  of  therapi sts  held  There w i l l  the  be  delivery by  a  significant  systems  clinical  difference in  preferred  therapi sts  by  and  the  clinical  supervi sory  therapists. Delivery systems,  such  educational tend  t o be  schedule more  of  able  systems as  can  be  workshops  television  and  categorized or  t r e a t i n g p a t i e n t s , one the  either  systems,  r a d i o . Because s u p e r v i s o r y  i n a p o s i t i o n where t h e y  to attend  distance  as  are  not  committed  would expect  programs u s i n g  direct  they  direct such  as  therapists to a  rigid  would  be  d e l i v e r y systems  56  which are  fixed  i n t i m e and  primarily  involved  flexible  i n terms of  systems.  Again,  would p r o j e c t to c l i n i c a l  with  4:  therapi s t s .  metropolitan  the  nature  British  the  only  activities  to  therapists  meet  tend  therefore  are  have  the  and direct  delivery  are  thus  less  delivery  supervisory  preferred  be  therapists systems  a significant difference  health the  to  t h e r a p i s t s and  care  be  of  5: higher  in a  out the  on  in  urban  institutions  with  non-  therapist  wide  job.  in  urban  region.  a  generalists,  more s p e c i a l i z e d w i t h to  delivery  rural occupational  carry  demands  in large  relevant  signi ficantly  Rural  range  While  rural  therapists many  of  are  therapists  fewer a r e a s of  clinical  them.  Rural  clinical  e s t imate  of  therapi sts learning  will  have  need than do  a  urban  therapists.  Rural  therapists  of  other  are  frequently  t h e i r geographic therapists  continuing  education  would e x p e c t knowledge  using  rural clinical  of  the to  employed  Hypothesis  with  care  rehabilitation specialist  frequently  because  of  Columbia,  therapists  clinical  that  will  i d e n t i f i e d by  B e c a u s e of  competence  likely  There  clinical  and  patient  however,  therapists.  needs  typically  staff,  programs  their perception  l e a r n ing  often  is  . Their  direct  attending  it  Hypothesis  is  place  and  more  than  r e m o t e n e s s have  minimal  programs.  rural therapists their  sole  to  opportunity B e c a u s e of require  urban  charge  staff  infrequent  and  contacts  to p a r t i c i p a t e this  updating  colleagues  in  isolation,  one  of  and  who  skills have  easier  57  access  to  continuing  education  programs  and  information  be a s i g n i f i c a n t  difference in  exchange. Hypothesis barr i e r s  to  6:  There  will  participation  ident if ied  t h e r a p i s t s and urban c l i n i c a l Because rural  of t h e g e o g r a p h i c  would  as  barriers  indicate  inadequate  isolation,  that  transportation  and  identify  barriers  such  urban  as  therapists  scheduling  or  notice. 7:  There  systems p r e f e r r e d  urban c l i n i c a l Because  of  that  will by  be a s i g n i f i c a n t d i f f e r e n c e i n rural  clinical  therapi sts  and  therapi sts. the  tendency  p r o g r a m s t o be l o c a t e d expect  clinical  one would e x p e c t  p a r t i c i p a t i o n while  institutional  Hypothesis delivery  to  rural  therapi sts.  t h e r a p i s t s would more o f t e n  distance  by  rural  continuing  education  barriers,  one  distance  access  to a greater  Vancouver  therapists  the  continuing  and  Victoria,  anticipate  delivery  that  these  rural  s y s t e m s more than  number  education one  would have d i f f i c u l t y  p r o g r a m s . As a r e s u l t o f  would  prefer  in  for  attending geographic  t h e r a p i s t s would  u r b a n who  of d i r e c t d e l i v e r y  would  have  easier  programs.  Sample  The  population  therapists Columbia. selection  studied  practising The  sample  was b a s e d  included  full  a l l qualified  time  consisted  or of  part 295  in  British  therapists.  Sample  upon t h e r e s p o n d e n t ' s b e i n g  time  occupational  an a c t i v e member  58  of  the  British  Columbia  Society  (B.C.S.O.T.) a s o f December questionnaire, stating  that  their  Society  of  excluded  from  who  The  fact.  the study  sample  the  was  grouped  I t was t h e n  the  second  recombined  previously  be a p p l i e d The  studied, 8) to  and  highly  no a t t e m p t  b e c a u s e of training,  the and  to  professional  these  of r u r a l  data  therapists  health  care  with  s e t of  geographic will  be  s a m p l e s were n o t  i n the r u r a l therapists  are  in  delivery. the  in  population Stan  the  therapists  settings, systems,  in  c a t e g o r i e s can  Columbia.  included  work  delivery  of  areas.  work  i n the province  was made t o r e p r e s e n t  health  role,  subgoups  subgroups  care  in British  85% o f a l l t h e r a p i s t s  similarities  gathering  and u r b a n  and s u p e r v i s o r y  representitive  t h e B.C.S.O.T. and t h e r e f o r e  Although  the  of s u p e r v i s o r s  i n the case of r u r a l  that  of  into rural  the m a j o r i t y  occupational  estimates  therapists  g e o g r a p h i c and r o l e d e f i n i t i o n s  thus the c l i n i c a l  sample was  the t e n  s e c t i o n . These  by c o m b i n i n g  stated,  the  s o and was  t o examine t h e f i r s t  to define  of t h e l i m i t e d number  isolation not  used  notify  did  s e t of h y p o t h e s e s d e a l i n g  i n the instrumentation  As  In a d d i t i o n ,  who d i d n o t  to  individual  i n order  described  because  month  according  The c r i t e r i a  further  Individuals  test  newsletter  t h e sample.  location.  subdivided  d i s t r i b u t i n g the  made a v a i l a b l e t o t h e  one  one  pilot  from  and s u p e r v i s o r s ,  hypotheses. test  in  study.  were g i v e n Only  Therapists  i n t h e B.C.S.O.T.  was b e i n g  sample.  were e x c l u d e d  clinicians  to  this  participated  instrument  was p l a c e d  f o r p u r p o s e s of t h i s  name r e l e a s e d  Occupational  1, 1981. P r i o r t o  t h e membership l i s t  investigator want  a notice  of  (Note belong  sample.  i n Canada,  professional this  s t u d y has  59  implications  for Canadian  t h e r a p i s t s in  Data  general.  Collection  Instrumentat ion The for  questionnaire  this  study  therapists survey items  ( A p p e n d i x A)  of  continuing  in British  Columbia.  questionnaires in t h i s  was  education Although  were r e v i e w e d  questionnaire,  developed  none of  the  for  a  i n the  specifically occupational  number  of  other  c o n s t r u c t i o n of  items  had  been  the used  previously. The first  questionnnaire  s e c t i o n focuses  relation the  to  of  divided  the  was  l o c a t i o n and  role  as  relation  as  completed  to  a clinician, what  they  preferences  t o be.  identifies  perceived  education represents  and  The  either first  t h e r a p i s t s completed  respondent  the  three  of  the  clinical  s e c t i o n , the by  i t e m s as  barriers of  a l e a r n i n g needs  respondent  in  of  two  d e l i v e r y s y s t e m s . The  or the  to  the  responded  in  staff's the  of  on  subsamples.  pertained  participation  assessment.  Based  remainder  the  they  their  section to  The  therapist  supervising therapists considered  sections.  functional role.  differently  second  preferences  into  definition  t h e r a p i s t i n the  questionnaire Clinical  on  geographic  definition  supervisory  is  needs  and  questionnaire in  continuing  third  section  60  S e c t i o n I_ The  first  respondent's questions  in  geographic  examining  therapists. or  item  In t h i s  than  these  questionnaire  location.  differences study,  t h e Lower M a i n l a n d  other  the  urban  This  urban  i s defined and  as  is  any  based  t h e r a p i s t s i n any s i n g l e  outside  Vancouver  Victoria.  respondents not  be  reside  in small  considered  professional  as  urban  education  larger  centers  special  interest  library  facilities.  questionnaire  as  groups,  recognize  their  familiarity  B.C.S.O.T. geographic providing The discuss the  In  those  the  of  distribution  that  this  education  programs,  used  and  i n the  bases  that  their  the respondent  i n Item being  provides  the  resources,  districts  categories  of can  characterize  district  item  number  of c o n t i n u i n g  B.C.S.O.T.  1 b e c a u s e of members  information  of  on t h e  o f t h e r a p i s t s w h i c h has i m p l i c a t i o n s f o r  on  programs t o those the  geographic  differences  in  rural therapists.  questionnaire,  p r o f e s s i o n a l p r o b l e m s and i s s u e s ,  by  lack  university  the  these  non-metropolitan item  that  appropriate  with  p r o p o s i t i o n that  explained  of  inter-hospital use  a  location  i n B.C., t h e s e  upon. I t was assumed  addition,  second  because  The s e v e n g e o g r a p h i c  membership d i s t r i b u t i o n would  elsewhere  opportunities  such  are  cities  Although  location on t h e low  of o c c u p a t i o n a l and  rural  as e i t h e r Vancouver  rural  definition  and  concentration of  the  r e l a t e s t o the research  between  and V i c t o r i a  two.  This  defines  i s designed  differences the  opportunity  frequency  may of  be  to  to assess partially  professional  contact. Definition  of the respondent  as e i t h e r a c l i n i c a l  therapist  61  or  a supervising  definition  occurs  definition  of  profession will  of  listed  be  remaining level  functional which  i n the  role  one  they  as  and  the  a means of assumption  supervising  a questionnaire definitions Those  that  must did  i n most  two  three  study.  to  frequently.  job  t h e r a p i s t s under  and  clinical  valid  the  meet  this  criterion  asking  the  the  second their  identify  third  level  groups. This  item  is  respond  0  1 or more. In o r d e r  in this  therapist  study, a l l  i n the  were  of  respondent's  therapists will  respond  considered  and  the  the  titles  assess  The  The  on  category  categories  identify  not  first  d i s t i n g u i s h i n g the that  i n the  studies  therapist  to the  The  respondent's  t h e r a p i s t c a t e g o r y . The  therapists will t o be  manpower  the  number of  3-5.  of d e f i n i t i o n .  therapist  supervising  function  direction  the  the out  level  t h e r a p y . The  in r e l a t i o n  uses the  on  from  asks  items  ones s e t  first  clinical  definition  in  to ensure that  i s the  i n the  definition  based  title  occupational  ones  of  steps  derived  considered  undertaken  terms match t h e  job  are  of  is  in three  these  Specification choices  therapist  for three  same c a t a g o r y .  excluded  from  the  under  the  sample. Item  5,  r e s p o n d e n t ' s d i r e c t i o n was differences perception  in of  education.  Item  explaining  6,  therapy,  years  of  needs extent was  therapists  t o examine  therapist's  the  staff  and  preferences  of  professional  used  to  assess  of  needs  supervising  effect  s i z e to  of  their  in . continuing experience  the  functional role  in perception  t h e r a p i s t s and  of  used  e x p e r i e n c e and  differences  between c l i n i c a l  also  supervising  clinicians  occupational between  a  number  in  relationship in relation  and  to  preferences  therapists.  62  Sect ion The  11  reasons  education Panocha  why  therapists  p r o g r a m s were (1979)  state  identified that  needs s u r v e y s  in continuing  factors  limit  high  which  interest  may  outweigh  participation,  or  need may  in  of  which are can  dispositional  was  used  identified  in in  therapists,  It  should  noted  in  her  that  in  the  self-perception type  were  in  using  Preferred variable  that  delivery  Item .2 were d e r i v e d  be  included  found  identify  although  to  for  self  factors  health  are  (Cross,  and  among the  This four  therapists,  urban  related  learner. because  are  either  1980).  therapists.  to  barrier  attitudes  Barriers the  seldom e x p r e s s e d  review  as  of of  barriers  design. the  questionnaire.  with  to  care  as  clinical  study  the  professional  categorized  a  in  in order  the  differences  as  non-  in t h i s study  in  are  a  participation  in continuing  barriers  from the  reviewed  that  manipulated  nature  s y s t e m s was  i n the  f a i l u r e to  i d e n t i f i e s a t h i r d t y p e of  from  they  most  with those  study,  a self-report  considered  literature  the  excluded  revealed  studies  about  l i m i t a t i o n s of  reasons  rural therapists Cross  and  barriers  be  assessing  typology. Dispositional  literature  the  barriers  barriers  supervising  in  could  continuing  Smorynski  state  identifying  participation  majority  or  this  the  that  institutional  and  exist,  1.  i s the  process  These  be  education  i s provided  literature.  subgroups  major  planner  studies  distinction  the  the  p a r t i c i p a t i o n . The  the  Item  By  increase  education,  of  attend  in  intention.  planning  on  one  not  p a r t i c i p a t i o n . They  program  based  do  second program The  eight  most commonly c i t e d consideration  for  planning  alternatives systems the  in  resources  63  that  are  a v a i l a b l e to occupational  present  time.  distance  delivery  used  and  rural  British  item  is  i n the  health  delivery detailed the  where s a t e l l i t e  system  negative biasing  information of  the  The  about  this  program  a  r e s p o n d e n t s answer  to  Item  section  learning  construction  of  this  the  assessment  to  be  what a r e  the  of  of  the  being  participant  measure up  closed  an  developed.  professional  between  of  has  education  specifically  with  by this  obtaining  in  more  relation  to  the p o t e n t i a l l y may  have  in  2.  of  the  a number of  valid, specific  assessed?  a  the  that  to  this  tool  states  what e x t e n t  activity?  respondents'  were  that  in order must  standards does t h e  These t h r e e  competency expertise  factors  issues  Is there  a  to  occupational  considered  following  standard?  using  in  important  performance  To  i s designed  therapists  i n s t r u m e n t . He  educational  which  questionnaire  a needs a s s e s s m e n t  profession  evaluation  be  circumstances  single choice  needs of c l i n i c a l  the  upon  between  III  development  basis  the  television  outweighs  on  the  by  special  d e l i v e r y system  therapy. Nowlen(l980) d e s c r i b e s  addressed:  distinction  importance  planning  at  differences  the  dealing The  B.C.  educational  focussing  third  the  item  included.  e f f e c t that  Sect ion  assess  was  an  in  systems which w i l l  of  in continuing  professions,  the  non-distance  t h e r a p i s t s . B e c a u s e of  Columbia  practise  on  identification  become a v a i l a b l e f o r use the  based  s y s t e m s and  specifically  urban in  The  therapists  of  in in for be the  potential  gap  to  be  points  are  the  statements in these  areas  and was  64  The  use o f competency  educational  need  incorporating  exists  tool.  performed,  work-related  profession  (American  competency  areas  of  student level  of  evaluating  know i n o r d e r  of  attempt  apply  Occupational  the  Therapy,  a  work  field  in  and  education  literature  reveals the past  that  to  be  specialization. these  that a  c o m p e t e n t l y a s an  robust  entry-  education  and p r o m i s i n g  (Canadian  with  has  areas  of  reveals  no  Association  The use of competency  Because  of  statements  needs  the  roles  occupational  assessment  therapy  programs  is  the m a j o r i t y  difficult. of  tools  to  A review that  conditions  or  have  and t y p i c a l l y  The use o f c o m p e t e n c y Because  the  statements  in  occupational  profession  as  a  single  purpose  therapy  entity  biased  statements  rather  to  of the been  have  t o one a r e a o f can  of d e v e l o p i n g was  base  therapeutic  o f a needs a s s e s s m e n t . These t o o l s  inconclusive  problems.  i s so  of t h e t h e r a p i s t s c o n t i n u a l l y  use e i t h e r ' c l i n i c a l  t e c h n i q u e s as the b a s i s tended  i n the  things  d e f i n i n g p o t e n t i a l a r e a s o f need upon w h i c h  continuing  used  diverse.  defined  expanding,  skillfully  a n a l y s i s , the l i t e r a t u r e  1980).  an  where t h e a r e a s o f s p e c i a l i z a t i o n a r e numerous and  settings  broadly  into  1973). The use  of c o n t i n u i n g  concept  of  make up t h e p r a c t i s e o f a  d e c r e a s e s many o f t h e p r o b l e m s a s s o c i a t e d in  practise  the important  the f i e l d  competency  manner  has been p r i m a r i l y  to function  a s one o f t h e most  application  direct  Association,  in education  and  a r e a s where an  significant,  that  Physiotherapy  t h e r a p i s t . Although  to  most  professional  activites  statements  been d e s c r i b e d  the  to identify  Competencies d e s c r i b e  defining  must  is  standards  assessment  of  statements  minimize competency  describe  than m u l t i p l e  the  a r e a s of  65  practise,  the statements are r e p r e s e n t a t i v e  situations The  than c l i n i c a l competencies  synthesis  of  those  included  of  Occupational  Therapy  tool.  relevance  to  patient  These  the  care.  The  clinical  Other  Of  t h e need and  statements existing  the  Canadian  and  the  American  The  present  could  interest interests activities  by Knowles  surveys are  and  expressions  whereas needs  of the l i t e r a t u r e  field  reveals  need  (1970) need  review  inventory  that  when  surveys. of  comparison  He  i n the  are a comparison of needs  the  & Upps,  1979;  of  among  The  or  between  alternative states. A  i n the h e a l t h  care  t o o l s were a c h e c k  educational  Hightower,  interest  1973;  need  educational  between two  assessment  majority  a need i s  program.  that  the  competency  distinguished states  a  competency  on a d i s c r e p a n c y  he  on  to  asked to i d e n t i f y  preferences  s t y l e and were m e a s u r i n g (Broski  the  the s c a l e  i n d i c a t e s that  the q u e s t i o n n a i r e  the  investigated.  assessment,  was  these  to  r o l e s of t h e t h e r a p i s t  of e x p e r t i s e  between  their  for direct  of a gap. F o r e a c h o f t h e  level  in this  of  relevant  be a d d r e s s e d by an e d u c a t i o n a l  of b a s i n g  emphasized  because  t o the p o p u l a t i o n  respondent  and d e s i r e d  difference  that  importance  the  30 were u s e d  were  and a d m i n i s t r a t i v e  of t h e needs  competencies  responsible  i s e s t i m a t e d , i s b a s e d on  listed,  136  chosen  that  are a  by  the  therapist  identification  level  were  competencies  s e c o n d component  standard  than  Therapy  items  were o m i t t e d a s n o t p e r t i n e n t  is  questionnaire  adopted  Association.  management, e d u c a t i o n ,  area.  this  of an e n t r y - l e v e l t h e r a p i s t , o n l y  assessment  which  in  Occupational  therapists'  areas.  officially  Association  required  specialty  o f more  McGregor,  list  rather Note  66  5). Smorynski & population  Panocha  using  an  (1979)  question  interest  survey  m e a s u r e o f p r o g r a m demand b u t make construction  of  a  tool  indicating  need by h a v i n g  desired  point  scale.  level  in this  level  method  no  is  study  defines  the  gap  or  on  from t h e d e s i r e d l e v e l ,  the  tool.  The  discrepancy  the respondent i n d i c a t e t h e i r  o f , e x p e r t i s e i n a competency  a  an a d e q u a t e  recommendations  By s u b t r a c t i n g t h e v a l u e a s s i g n e d  of c o m p e t e n c e  sampling  more a p p r o p r i a t e needs a s s e s s m e n t  assessment  and  whether  existing  a r e a on a t h r e e  to  the  existing  an e s t i m a t e  o f need  c a n be s t a t e d . In a d d i t i o n t o t h e i d e n t i f i c a t i o n the  r e l e v a n c e of each competency  clinical the  would  nature  of  occupational  of  vary  needs  of  the  programs.  planning, i f  need  becomes a p r o b l e m . I f , " h o w e v e r , and  to  give  Identifying  these  the  program  area at  programs.  Even  therapist,  t h i s does not p r e c l u d e  though  available  and  a  the  planner  helps  to  is  to planning educational  planner  training  competency  ranking  t h e r e i s an e s t i m a t e  of t h e needs assessment  whether  present  estimate,  vary,  in relation  The f o u r t h c a t e g o r y  designed  direction.  i t is  w i t h i n t h e sample. I n terms of program t h e same  of  practise,  competencies  p r o v i d e d w i t h more d i r e c t i o n  already  role  the  i m p o r t a n c e of each need,  also  therapy  t o assume t h a t i m p o r t a n c e o f e a c h  two c o m p e t e n c i e s a r e a s s i g n e d the  statement t o the  t h e r a p i s t i s i n d i c a t e d on a t h r e e p o i n t s c a l e . B a s e d on  diverse  logical  o f a n e e d , an e s t i m a t e o f  s c a l e was  more  specific  i s available  minimize  i n each  redundancy  in  need e x i s t s w h i c h i s r e l e v a n t t o t h e  that  the  the  a d v a n t a g e o f them f o r any number o f  fact  that  respondent reasons.  programs has  Another  not  are taken  possible  67  situation  that  may  exist  available  they  are  not  relevent  that  education this  Pilot  are  programs  successful  currently  Test  pre-tested  i n a needs  to c l a r i f y  the e r r o r by  Minor  changes  were  made  10  of  or  not  are  in  a  from  to  continuing  the i n c l u s i o n  assessment.  of  occupational  the competencies therapist.  questionnaire  the  needs  list  One  i n the study  was  sample.  Section  II  were  taken  by t h e C a n a d i a n and  Therapy,  no  attempt  was  of t h e s t a t e m e n t s a s r e q u i r e m e n t s therapists.  because  The p i l o t  to their  competency  t o the a d m i n i s t r a t i v e role.  items  questionnaire  assessment  approved  in relation  was d e l e t e d  the c l i n i c a l  the questionnaire  t e s t . B e c a u s e t h e competency  of Occupational  the v a l i d i t y  level  this  learning  made t o d e t e r m i n e  more o f t e n  support  i n the i n s t r u c t i o n s i n  composite  Association  clinical  offering  area  interpretaion,  response  directly  entry  in  the wording'of  i n the wording  i n the  American  care  sufficently  t h e r a p y . The number o f  t h e r a p i s t s not i n c l u d e d  statements used  than  t h e programs a r e  of Instrument  order  reduce  assess  although  involved  i n the health  information  In and  that  t o the p r a c t i s e of o c c u p a t i o n a l  agencies  of  is  relevance  included  the  to the  on t h e o r i g i n a l  i t was u n c l e a r r o l e of  group d i d  i f i t pertained  therapist  rather  68  Procedures The the  co-operation  Health  Sciences  undertaking  of  and  this  the  of b o t h  implications  the  the  B.C.S.O.T.  questionnaire C).  - In  B.C.S.O.T.  addition,  attempt the  in  order  to  to  A letter  that  was  visit  explain of  time  be  membership b a s i s of  identify  to  made  to  purposes  and  obtained  from  was  included  t o maximize r e s p o n s e  with  rate  list  was  the  sample.  the  (Appendix  provided  non-respondents  in  prior  was  the  support  to  Education  enlisted  personal  agencies  study. at  i n an  A  B.C.S.O.T. w h i c h became t h e coded  D i v i s o n of C o n t i n u i n g  study.  representitives of  the  by  the  The  list  was  for  follow-up  purposes. The  q u e s t i o n n a i r e was  (Appendix  B)  and  membership l i s t . opportunities pamphlet These  for  items  continuing field  of  materials something sample,  f o r the an  support  education  experienced  needed  activities.  had  of v a l u e  therapy to  t h a t the The  in  illustrate  to  of c o n t i n u i n g and  reasons.  or p o t e n t i a l  r a t e may  be  such  the  letter  a  the  education  promotional  because  profile  few was  in  years,  some p l a n n i n g  for including  that  increased  often  t o the  by  providing  individuals 1979).  second  mailing  was  conducted.  used  additional  (Payton,  a  the some  i n f o r m a t i o n would be  value  non-respondents'  a low  past  reason  before  Firstly,  that there  survey  second  F o u r weeks were a l l o w e d questionnaire  two  t h e q u e s t i o n n a i r e was  response  covering  t o a l l names on  f o l l o w i n g f o u r months  for  with  a  upcoming p r o g r a m were i n c l u d e d i n t h e m a i l i n g .  o c c u r i n g and  these  of  were i n c l u d e d  was  activity  letter  with  In a d d i t i o n , a s c h e d u l e  occupational  evidence  in  the  distributed  A  i n the  of  the  covering  69  letter  (Appendix  mailed  to  specified special  B) and a n o t h e r  individuals  who  i n the o r i g i n a l interest  newsletters reminding  had  groups,  reiterating  categories:  from  the  their  The  questionnaires  computer  disc  Package  using  frequency  data  the which  variables: under  frequency  Measures of a s s o c i a t i o n T-tests the  were t h e n  therapists to used  the three to  of  and  because  conducted.  order  In a  value  transferred to  of that for  the  of SPSS, t h e  the  biographic  on  the  following  role,  number  years  of  a  single  each  rural  chance of  of  competency  to and  test urban  relation  routine  was  significant  tests  estimate  staff  T a u , and  in  T-test  of  experience.  subgroups  therapists  number  a  from  between  by  needs.  statistics  sample  and c l i n i c a l  to  Summary  response  to the four  calculation  relationships  established,  were d e r i v e d  relationships  the  barriers  was  p r o g r a m v a r i a b l e s . The m u l t i p l e  avoid  and  four d i f f e r e n t  i n c l u d i n g C h i Square, K e n d a l l ' s  and s u p e r v i s o r y  the  study  U.B.C.'s v e r s i o n  direction,  applied  hypothesized  to  s y s t e m s and l e a r n i n g  l o c a t i o n , job t i t l e ,  respondent's  the  perceived  using  routine  geographic  sent  into  f o r the S o c i a l S c i e n c e s .  included  the  of  fell  were c o d e d and t h e d a t a  Statistical  were  deadline  Analysis  delivery  and a n a l y z e d  by t h e  was  questionnaires.  data,  preferred  questionnaire  g r o u p , and p r o f e s s i o n a l  importance  the q u e s t i o n n a i r e  biographic  participation,  Notices  supervisor's  t h e r a p i s t s to return  data  the  not responded  letter.  Data  The  copy of  of  that need  were be  was c a l c u l a t e d by  70  subtracting assigned assigned  the value  to desired to  The p o t e n t i a l  the  assigned  need and m u l t i p l y i n g relevance  need e s t i m a t e  a b s e n c e of need  t o e x i s t i n g need  t o 6,  t h i s value  of t h e competency could  from  r a n g e from  the by t h e  t o the 0,  value value  therapist.  indicating  i n d i c a t i n g a s i g n i f i c a n t need.  an  71  CHAPTER  FOUR  RESULTS  This the  chapter  analysis  presented  presents  of t h e d a t a  i n Chapter  the f i n d i n g s  c o l l e c t e d using  of t h e sample w i l l  by  associated  survey  with  be p r e s e n t e d  the f o l l o w i n g  1) l e a r n i n g  needs and p r o f e s s i o n a l  2)  needs and g e o g r a p h i c  learning  the  T h r e e . The r e s u l t s d e s c r i b i n g  characteristics the f i n d i n g s  of t h e s t u d y  b a s e d on  instrument the relevant  first  followed  relationships:  role  location  3)  perceived  barriers  to  p a r t i c i p a t i o n and  4)  perceived  barriers  to  participation  professional  role and  geographic  l o c a t ion 5) p r e f e r r e d  delivery  s y s t e m s and p r o f e s s i o n a l  6) p r e f e r r e d  delivery  s y s t e m s and g e o g r a p h i c  In  addition,  postulated  will  a  number  be p r e s e n t e d  of  Response  The  response  rate  percentage  of  predetermined  cutoff  the  total  sample  in  mailed date  (285),  this  location  relationships  as r e l e v a n t  role  not  formally  to the study.  Rate  study  questionnaires  was  measured returned  s i x weeks a f t e r t h e f i r s t  by by  the  mailing.  1 8 2 ^ q u e s t i o n n a i r e s were r e t u r n e d ,  the  Of  176 of  72  them u s a b l e . yields  a  excluded of  63.85% from  the  60%  the  nature.  the  could  average  the  holidays factor  somewhat out were r e t u r n e d returned surveys  the  of  becoming  a  Although  these  others  very  i n the  disregarded  the  address as  the had  out  list  small  comment been  time three  relatively minimal  well  general  the  this have fact  December  overload  individual's study.  A  second  to mail q u e s t i o n n a i r e s the  was  19 q u e s t i o n n a i r e s  this  and  was  only  months and frustrating  respondents completed similar  the  one that  at  take  which  number o f q u e s t i o n n a i r e s  consuming  have had  of  The  of  mail  40%-  may  study.  to the  to  between  month  many  in recent  were  of many it  was  exercise.  questionnaire,  experiences  and  simply  questionnaire.  Characteristics  Because the  that  r a t e . The  that  sent  response  questionnaires  response used  criteria  rate according  particular  that  the  the  f a c t o r s which  during  i n d i c a t e d by  sample may  the  estimate  return  questionnaires  meet  response  in t h i s  total  i n c l u d e d , the  mailed  fact  undelivered. A  they  not  response  reduced  date  bearing that  the  plus  have  i s that  rate  carried  decreased  may  are  for  six  d i d not  acceptable  rate  response  t i m e of y e a r  the  however, a number of  m a i l i n g was  have  they  definition  i s an  r a t e b a s e d on  If  C u r r i e r (1980) who  There are,  influenced that  role  (1979) and  is  rate.  sample b e c a u s e  i s 61.75%. T h i s  Payton  response  response  professional  rate  that  C a l c u l a t i n g the  of  problem  which  focussed  and  demographic  this  the  data  Respondents  study  investigated  variables clearly  was  solicited.  was  delineated,  Common v a r i a b l e s  73  s u c h as  age,  because  educational  occupational  therapists  homogeneous i n r e l a t i o n this  study.  follows: number  The  may  sex  be  were  not  considered  d e s c r i p t i v e data role  and  year-s - e x p e r i e n c e ,  tapped  in this  title,  and  assessed  sufficently  t o t h e s e v a r i a b l e s f o r the  professional of  b a c k g r o u n d , and  purposes  of  s t u d y were  as  geographic  opportunity  location,  for p r o f e s s i o n a l  contact.  Professional  Role  Of  the  and  37  (21%)  Used  in t h i s  other  176  supervisory study. This  studies  methods  represents title.  the  and  as  therapists.  positions there  In  professional  as  was  the  support  two  this  distinct  only  allied  therapy;  size,  w h i c h does not  the  suggest  easily  that  lend  health  one  the  on  of  departments are  itself  to a broad  Table  1 job  categories,  respondent 26  as  was  senior  among  growth  prof e s s i o n s .  size  for  to  consultant  s c a l e s of advancement data  similar  describing  job  and  one  in  occupational  in  method  according  supervisor was  a  literature  finding considering  graded  using  supervisors.  sample  unexpected  few  definition  findings  as  sample, o n l y  assistant  other  with role  or  the  with  a d d i t i o n , there  t o the  solicited  clinicians of  In  therapists  1967).  title  a field  an  have been  department  job  distribution  as  were c l i n i c a l  is consistant  Price,  administraton.  classified  an  result  results  rehabilitation  (79%)  therapists according  respondents  The  sample,  1980;  respondent's  classifying  139  investigating  (Chatham,  The  staff  respondents,  of  the such  Traditionally  i n the  staff,  field  of  indicating  small, a s i t u a t i o n range of  levels  of  Table 1 Distribution of Occupational Therapists by Job T i t l e  Job Title  Number of Responses Urban Rural Total  Adjusted % Sample Urban Rural  Total  Staff therapists  76  14  92  45.9  8.2  54.1  Senior therapist  20  6  26  11.8  3.5  15.3  Sole charge  10  13  21  5.9  6.5  12.4  1  0  1  0.6  0.0  0.6  21  4  19  8.8  2.4  11.2  Program Co-ordinator/ Director  4  3  7  2.4  l.a  4.1  Instructor/Professor/ Lecturer  3  0  3  1.8  0.0  1.8  Consultant  1  0  1  0.6  0.0  0.6  136  40  176  77.3  22.7  100.0  Assistant supervisor Supervisor  Total  —J It*  75  responsibi1ity.  Staff  Size The  was  size  assessed  the  of t h e d e p a r t m e n t s w h i c h  i n the item  respondent's  Table  2.  An  clinical  indicate staff.  direction.  assumption  therapists  therapists  asking  t h e number o f  respond  that It  i n s i x cases,  is  possible  clinical  that  of  in  of r e h a b i l i t a t i o n .  the f i e l d  that  the  non-professional  individual,  administrative role  this the  the  they  response  these  was  the  supervising  relation  t o how w e l l  staff  cases  on a c o n t i n u o u s Considering  may  other  indicate  common  situation  and  of  time  therefore  study  as  as  for a i n an  identified a  clinical  n o t be c l a s s e d a s e i t h e r  t h e sample.  indicated of f i v e  for  In r e l a t i o n t o  above,  the  most  o r fewer t h e r a p i s t s ,  category.  staffs  the supervisors  has  know t h e i r  The s m a l l  sizes  implications staff  of the  basis. in relation  in  and t h e  t h e needs and p r e f e r e n c e s  the d i s t r i b u t i o n  is  t o the d e f i n t i o n s adopted from  therapists'  responsible  amount  could  i n that  f o r them t o a s s e s s  a very  this  a department  responded  the supervisory  numbers  role of  size,  the  therapists supervised  minimum  according  of s t a f f  that  c a t e g o r i e s . The r e s u l t s  technically  were e x c l u d e d  of t h e sample  opportunity  a  purposes  or s u p e r v i s o r  distribution  92.3%  while  was  Another p o s s i b l e e x p l a n a t i o n  supervisory  Because  study,  common  of  or  for  therapist. clinician  zero  staff,  although  number of t h e r a p i s t s , s p e n t  their  item  these  supervision  under  i s represented i n  this  would c h o o s e one of t h e o t h e r  managed  therapists  The d i s t r i b u t i o n  underlying  would  the s u p e r v i s o r s  t o geographic  Table 2 Number of Occupational Therapists Under Respondent's Direction  Staff Size  Urban  Number of Responses Rural Total  Adjusted % Sample Urban Rural  Total  0  therapists  99  34  133  58.2  20.0  78.2  1-5  therapists  20  4  24  11.8  2.4  14.1  6-10  therapists  6  1  7  3.5  0.6  4.1  11-15 therapists  3  0  3  1.8  0  1.8  More than 16 therapists  3  0  3  1.8  0  1.8  —  —  —  77.1  22.9  100.0  Non-respondents Total  —  —  6  131  39  176  77  location,  o n l y one o f t h e 40 r u r a l  department number  o f more t h a n  of  combined rural  rural  with  suggests  and urban  skills  The  therapists small  relatively  indicated  size  in a  of  large  in Table 1  departments  in  that  differences  c o u l d be e x p e c t e d between  therapists  in relation  t o how  they  update  their  of Employment The  average  occupational years,  (Note  with  professional  care  part  likely  results  among worked  of  remain  10.42 w h i l e  less  than  that  found  among  was  7.49  one y e a r  t o 30  i n McGregor's  a  clinical  and l e v e l  study.  women  health  or r e t u r n least  a  i n the s u p e r v i s o r y  therapists  assumption  t h i n g s , t o t h e number  averaged  of o c c u p a t i o n a l t h e r a p y . on t h e  of j o b r e s p o n s i b i l i t y ,  an a d m i n i s t r a t i v e p o s i t i o n  field.  the  (1973)  t o work on a t  experience  i n the f i e l d  common  than  i n t h e work f o r c e  i s no c u r r e n t i n f o r m a t i o n a v a i l a b l e  of e x p e r i e n c e  i n the  study  children. years  of e x p e r i e n c e  reflect  other  this  a general trend  having  number  g r o u p was  there  attaining  than  an a b s e n c e and t o c o n t i n u e  mean  years  in  from  higher  to either  The  Although  sample  i n the f i e l d of  r e p o r t e d i n the Hightower  reflect  basis after  years  experience  w h i c h was 6.8 y e a r s and 3.5 y e a r s more  time  6.75  for  is slightly  professionals  therapists  years  ranging  experience  work a f t e r  of  f o r the  responses  5) s t u d y  results  number  therapy  y e a r s . The mean  to  charge  was employed  and knowledge.  Years  The  sole  therapists.  the c o m p a r a t i v e l y  areas  rural  five  respondents  of  among  therapists  can u s u a l l y  be  years  therapist  the  norms these that  attributed, has  78  Geographic  Locat ion  Applying adopted to  the  in this  study,  geographic  and  19%  according  t o the  Table  3.  occupational large  is  therapy,  (Maxwell,1977; This most  therapists located  are  of  funding  and  outlying  health  areas.  units  have  occupational personnel  distribution explained  by  opportunities, for  personal  according  of  be  the  fact  in rural  the  in  the  is  sample in  of  urban  the  the  in  This  data  represented  in  for  in  field  of  located  in  Victoria  i n a number of  majority  if  a r e a s may  that do  reflect  small  the  another  not  for  geographic  to p r o f e s s i o n a l r o l e i s presented  lack  of  and  rural  opposed  to  for  could  available  distribution  small  rehabilitation  pattern  c h o o s e t o work  are  services  explanation  The  despite  the  communities  funding  study.  the  health  as  of  which  i s that  for a l l i e d  ways.  employers  hospitals  physiotherapists  is  this  of  consideration  rural  This  r e a s o n s . The  areas.  were l o c a t e d  rehabiltation  Another  therapists  of  located  t h e r a p i s t s are  accounted  employed  in  respondents,  c a s e V a n c o u v e r and  Traditionally,  found  according  research  opportunities  limited.  therapists  7).  and  therapists  is  other  i s that  therapists therefore  therapists  regions  in this  can  acute  139  rural  d e t a i l e d breakdown of  majority  Note  i n urban a r e a s .  numbers  in  in  factor  of  therapists The  areas,  distribution  and  respondents,  of  the  Scott,  likely  37  provincial  seen  metropolitan  77.3%,  areas.  seven  urban  actual distribution  81%  in r u r a l  As  was  the  approximately  a r e a s and  The  of  of  distribution  22.7%, or  representative  which  the  location  urban c e n t e r s is  definition  also  in Table  be  employment  in r u r a l of  the  areas  therapists 4.  As  was  Table 3 Distribution o f Occupational Therapists by Geographic Location  Location  Adjusted % Number of Sample Responses C l i n i c i a n s Supervisors Total C l i n i c i a n s Supervisors T o t a l  Vancouver S Lower Mainland  96  29  125  54.5  16.5  71.0  Victoria  10  1  11  5.7  0.6  6.3  Vancouver Island  9  4  13  5.1  2.3  7.4  Fraser V a l l e y  5  0  5  2.8  0  2.8  Thompson/Okanagan  8  0  8  4.5  0  4.5  Northern Interior  6  0  6  3.4  0  3.4  Central I n t e r i o r  5  3  8  2.8  1.7  4.5  139  37  176  79.0  21.0  100.0  Total  vO  Table 4 Distribution of Therapists' Professional Role by Geographic Location  Geographic Classification  Clinicians No. of % Response Sample  Supervisors No. of ? Response Sample  Total No. of % Response Sample  Urban  106  60.3  30  17.0  136  77.3  Rural  33  18.7  7  4.0  40  22.7  Total  139  79.0  37  21. Q  176  10Q.O  81  anticipated, rural  very  areas,  few  in this  supervisory  sample  only  7 of t h e 40  were l o c a t e d o u t s i d e of V a n c o u v e r  Opportunity  or  item  respondent  had  p r o b l e m s and  was  designed  t o meet w i t h  issues. Table 84.7%  f e l l o w t h e r a p i s t s on a t l e a s t  expect  that  areas,  within a hospital  information  relation  professional  to  for  weekly  than  g r o u p met  a l a r g e number of t h e r a p i s t s i n B r i t i s h  Learning  Needs  of t h e p u r p o s e s o f t h i s  study  total  defined to  assist  need e s t i m a t e  was  the in  indicated  colleagues  for  The  group  than  that p r o f e s s i o n a l i s o l a t i o n  i n order  would  in metropolitan  with  results  need  One  urban  The  educational  a  of t h e g r o u p l e s s  which  t o meet  did  less  process  that  and o p p o r t u n i t y f o r  as  or  assessment  basis.  location  therapists  60% of t h e r u r a l  suggest  showing  great.  contacts  f r e q u e n t l y , 22.5%  professional  opportunities for professional  geographic  contacts, rural  opportunity  Approximately  be  that the  had o p p o r t u n i t y  of t h e r a p i s t s worked  setting,  would  a  discuss  the r e s u l t s  o f t h e sample,  i f the m a j o r i t y  exchange  to  5 represents  with  process.  respondents  the o p p o r t u n i t y  colleagues  respondents,  One  (22.7)  Victoria.  to assess  149  less  are located in  for P r o f e s s i o n a l Contacts  This  In  therapists  therapists.  once  may  weekly monthly.  be a p r o b l e m  Columbia.  to  develop  component the  needs  p a r t s of an  program  f o r e a c h competency  a  was  planning made up  82  of  three  factors: desired  level  competence,  and  occupational  therapy. Tables  competencies, to  relevance  role  r e s u l t s of the t o t a l  which  continuing  compared  skills,  ranked  felt  Competencies  the  that  rehabilitation,  The  Materials  are In  that  the  expertise  in  equipment  and  responsibility  current the  materials  It apply  area  many  skills  field of  Therapeutic for  retail  outlets  total  than  aids,  offering  therapists  f a c t o r that  estimate  therapy  the  the  therapeutic  the  Another need  by  of p r a c t i s e .  of  minimized  use  of  study.  or a c t i v i t y  supply  as  motor  low i n t h i s  area  of o c c u p a t i o n a l rather  the  in this  area.  The most  competencies.  accounted  and  have  of  in  realm  evaluation  rehabilitation  competency  i n the f i e l d  use of a d a p t i v e  overcome  may  the  vocational  the U t i l i z i n g  may be  of  f o r the d i s t r i b u t i o n trend  and  to  relatively  prescription  in this  the  related  and  the t h e r a p i s t  expansion the  in relation  need e s t i m a t e s .  related  under  category  thirty  n e c e s s a r y . E v a l u a t i o n of  motor  mobilization  to replace  is  function,  are t r a d i t i o n a l l y  para-professionals,  addition,  account  or  of t h e c o m p e t e n c i e s  beginning  rank  t o be i n t h e p s y c h o - s o c i a l  physical  and Equipment  each of the  evaluation  among t h e t o p f i v e  joint  t o the p r a c t i s e of  location. Considering  most  f o r example, were r a n k e d  absence  fact  is  e x i s t i n g l e v e l of  and t h e i r  cognitive  needs a p p e a r  to  function  sample,  education  motor  are  strongly  6 and 7 p r e s e n t  and g e o g r a p h i c  ranked  skills  o f t h e competency  t h e mean need e s t i m a t e ,  professional  perceptual  o f competence,  may  i s the  t o encourage of  aids  to  dysfunction. is  interesting  directly  t o note  t o the f i e l d  that  t h e two c o m p e t e n c i e s  of gerontology  a r e ranked  that  near t h e  Table 5 Number of Opportunities for Professional Contact with Other Occupational Therapists  Opportunity for  Number of Responses Urban Rural Total  Adjusted % Sample Rural Urban  Total  Daily  97  17  114  55.1  9.7  64.8  Weekly  29  6  35  16.5  3.4  19.9  Monthly  7  8  15  4.0  4.5  8.5  Less than six times annually  3  9  12  1.7  5.1  6.8  40  176  77.3  Total  136  22.7  100.0  CO LO  Table 6 Total Need Estimates by Profession Role  Clinicians n = 139  Occupational Therapy Competencies  1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30)  identify 6 evaluate motor function identify 6 evaluate perceptual-motor s k i l l s identify S evaluate sensory function observe E record cognitive function identify E evaluate leisure 6 play s k i l l s identify E evaluate vocational s k i l l s identify £ evaluate A.D.L. s k i l l s identify 6 evaluate functional communicating s k i l l s identify E evaluate psychosocial function conduct therapeutic interviews select 6 adopt a c t i v i t i e s for therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop perceptual motor s k i l l s employ joint mobilization £ protection techniques employ muscle strengthening techniques t r a i n i n work simplification 6 energy conservation techniques employ behavior modification approaches employ socio-drama techniques employ relaxation techniques employ r e a l i t y orientation employ activation methods u t i l i z e recreation 6 leisure time a c t i v i t i e s select £ u t i l i z e s e l f care equipment £ materials select £ u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select £ u t i l i z e avocational equipment £ materials select E u t i l i z e vocational equipment £ materials select £ u t i l i z e projective equipment £ materials select £ u t i l i z e developmental equipment 6 materials t = 2.03  X  Rank  1.65 2.57 2.17 2.53 1.04 1.64 0.84 0.98 1.11 1.41 1.24 1.50 1.92 2.10 1.40 0.96 1.10 1.59 1.00 1.13 0.82 0.67 0.87 1.22 1.37 1.33 1.52 1.78 1.45 1.57  7 1 3 2 23 8 29 25 21 14 28 12 5 4 15 26 22 9 24 20 28 30 27 19 16 17 11 6 13 10  Supervisors n = 37 Rank  X  1.73 1.70 1.68 2.35 1.76 2.08 1.27 1.54 1.76 1.35 1.65 1.59 1.73 1.05 0.76 0.54 1.08 1.51 0.84 1.60 0.95 0.73 0.78 1.14 0.84 1.27 1.43 1.54 1.62 1.27  a  4 5 6 1 3 2 15 11 3 19 7 10 4 18 22 29 17 12 20 9 19 23 21 16 20 15 13 11 8 15  Total Sample n = 176 X  1.65 2.39 2.05 2.50 1.20 1.72 0.92 1.'09 1.25 1.39 1.31 1.50 1.89 1.88 1.26 0.36 1.09 1.57 0.98 1.24 0.86 0.67 0.86 1.20 1.25 1.30 1.49 1.73 1.39 1.51  Rank  8  2 3 1 19 7 22 20 17 13 14 11 4 5 16 23 20 9 21 18 23 24 23 19 17 15 12 6 13 10  df = 175 p < .04  CO  Table 7 Total Need Estimates by (  Occupational Therapy Competencies  Urban n = 136  Rural n = 40 Rank  1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) _13) 11) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30)  identify 6 evaluate motor function identify S evaluate perceptual-motor s k i l l s identify 6 evaluate sensory function observe £ record cognitive function identify £ evaluate leisure 6 play s k i l l s identify £ evaluate vocational s k i l l s identify £ evaluate A.D.L. s k i l l s identify £ evaluate functional caimunication s k i l l s identify E evaluate psychosocial function conduct therapeutic interviews select £ adopt a c t i v i t i e s for therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop perceptual motor s k i l l s employ joint mobilization £ protection techniques employ muscle strengthening techniques t r a i n i n work simplification £ energy conservation techniques employ behavior modification approaches employ socic—drama techniques employ relaxation techniques employ r e a l i t y orientation employ activation methods u t i l i z e recreation £ leisure time a c t i v i t i e s select £ u t i l i z e self care equipment £ materials select £ u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select £ u t i l i z e avocational equipment £ materials select £ u t i l i z e vocational equipment £ materials select £ u t i l i z e projective equipment £ materials select £ u t i l i z e developmental equipment £ materials  * t = -1.99 df r 175 bt = -2.15 df r 175  p  p< <  .04 .03  1.58 2.39 2.07 2.44 0.88 1.66 0.70 0.75 0.99 1.48 1.03 1.45 1.78 2.02 1.89 0.99 1.05 1.42 0.85 1.14 0.64 1.00 0.79 1.11 1.26 1.27 1.44 1.71 1.31 1.46  6 2 3 1 23 7 27 26 22 8 20 10 5 4 16 22 19 12 24 17 28 21 25 18 15 14 11 6 13 9  x 1.33 2.67 2.09 2.42 1.49 1.45 0.76 1.58 1.36 1.09 1.45 1.00 2.33 1.94 1.94 0.70 0.79 2.00 1.45 1.09 1.36 0.42 1.09 1.58 1.70 1.48 1.73 1.94 1.81 2.03  Total Sample n = 176 Rank  a  v b  16 1 4 2 13 14 20 12 15 17 14 18 3 7 7 21 19 6 14 17 15 22 17 11 10 13 9 7 8 5  x 1.65 2.39 2.05 2.50 1.20 1.72 0.92 1.09 1.25 1.39 1.31 1.50 1.89 1.88 1.26 0.36 1.09 1.57 0:98 1.24 0.86 0.67 0.86 1.20 1.25 1.30 1.49 1.73 1.39 1.51  Rank 8 2 3 1 19 7 22 20 17 13 14 11 4 5 16 23 20 9 21 18 23 24 23 19 17 15 12 6 13 10  86  bottom of large  the  competency  number  of  'high p r o f i l e industry, ranked  22  the  the  the  6  of  are  ranked of  cognitive,  vocational, reported  competency a r e a clinicians considered greater the in  30  and  Again,  significant was  considered  areas  health  of  in  care  learning  needs  r e s p o n d e n t . As  seen  evaluation groups in  although  relation  to  sensory-based  as  while  cognitive  needs.  One  held  by  Clinicians  therapies  similar  in  existed.  t h e r a p i s t s . The  were p e r c e i v e d  role.  high  and  needs  to  the  evaluation  sensory,  in  related  relation  skills  learning  was  unexpected.  of  both  leisure  which  the  areas  of  remainder  of  by  both  groups  l e a r n i n g needs. need  when t h e  estimate  data  location  of  was the  in  according  employing  orientation  to  therapists.  This  be  in  respondents. of  socio-drama  techniques  greater  is surprising  There  need  were  to  the  were  two  needs when t h e  location.  of  areas  relation  to geographic  areas  finding  evaluation  analyzed  d i f f e r e n c e s in perceptions  compared  was  differed  did supervisory  the  geographic  the  perceptual-motor,  application  to  24  sample, by  the  and  t h e r a p i s t s ' needs t o be  and  supervisors  competency  illustrated  highly  area  showed a major d i f f e r e n c e i n p e r c e p t i o n s  need t h a n  relation  of  total  in  in  distribution  clinical  areas  comparatively  o r i e n t a t i o n competency  competency  evaluation  perceived  as  receiving reality  the  Supervisors  evaluation  the  the  the  opportunities in this  professional role  areas  clinicians  Considering  is  activation  analysis  specific  that  presents  t o the  competencies  field  fact  and  Table according  employment  that  the  list.  sample  Rural t h e r a p i s t s and than  c o n s i d e r i n g the  reality did  urban  generally  87  accepted  assumption  specialized  than  R e l e v a n c e of The  that  their  of  occupational  therapist  computation  of  the  total  in  practice in  the  the  areas,  of  if  one  rank.  and  ranked  e q u i p m e n t and  evaluation  less  one  is  aspect  of  the  of  of  are  and  The  in  decision of  needs  are  relevant to  the  influential  location  response  total  percent  of the  r e l e v a n t , with  of  daily  utilization top  the high  sample,  t h e most  in  of  of  a s c a l e the  activities  selection  In  of e a c h competency  frequency  self-care  areas  more  geographic  the  the  competencies a l s o r e f l e c t  and  Considering  those  clearly  relevance  five.  the  priority  that  another.  3 on  and  Of  indicate  as  to  in  i s important  program b e f o r e  study  the  f o r each competency a r e a .  would be  role  of  used  fact  The  m a t e r i a l s as  orientation.  factors  that  most commonly a s s o c i a t e d w i t h , living  be  role  is  evaluation  first  reflect  the  one  the  in this  related  identification  to  to  i n s t a n c e , when c o n s i d e r i n g t h e  9 present  defined  competencies  three  i t reflects  professional  and  skills  the  to  of e a c h competency a l o n e  respectively.  relevance, sample  of  t h o u g h t h e r a p i s t s may  8 and  to  respondent  one  occupational therapy,  Tables  tend  For  implementation  relation  competency  need e s t i m a t e  different of  was  in that  process.  p r o g r a m s , even equal  tend  colleagues.  each  relevance  program p l a n n i n g making  urban  therapists  Competencies  relevance  addition,  rural  ranked  of  living  self-care  competencies  that occupational t h e r a p i s t s are those  w i t h an  three broad  considered concepts  activity  c a t e g o r i e s of  the  most  that are  or  competency,  relevant.  i n common  daily  usage  These  V  Table 8 Relevance of Competencies by Professional Role  Occupational Therapy Competencies  Clinicians n = 139 -Number ~% Response Sample  Rank  67.4 95 1) identify £ evaluate motor function 61.0 86 2) identify £ evaluate perceptual-motor s k i l l s 53.9 76 3) identify £ evaluate sensory function 60.3 85 4) observe £ record cognitive function 53.2 75 5) i d e n t i f y £ evaluate leisure £ play s k i l l s 39.7 56 6) identify £ evaluate vocational s k i l l s 83.0 117 7) identify £ evaluate A.D.L. s k i l l s 83 58.9 8) identify £ evaluate functional ccmmunicaticnal s k i l l s 78 55.3 9) identify £ evaluate psychosocial function 96 68.1 10) conduct therapeutic interviews 106 75.2 11) select £ adopt a c t i v i t i e s for therapeutic purposes 77 54.6 12) design and adapt special equipment 61 43.3 13) employ counselling methods 72 51.1 14) apply sensory-based therapies to develop perceptual motor s k i l l s 54 38.3 44 15) employ joint mobilization £ protection techniques 31.2 69 16) employ msucle strengthening techniques 48.9 46 17) t r a i n i n work simplification £ energy conservation techniques 32.6 27 18) employ behavior modification approaches 19.1 52 19) employ socic—drama techniques 36.9 70 20) employ relaxation techniques 49.6 73 21) employ r e a l i t y orientation 51.8 67 22) employ activation methods 47.5 85 23) u t i l i z e recreation £ leisure time a c t i v i t i e s 60.3 77 24) select £ u t i l i z e self care equipment E materials 54.6 65 25) select £ u t i l i z e rehabilitation aids £ materials 46.1 44 26) select £ u t i l i z e mobility aids 31.2 36 27) select £ u t i l i z e avocational equipment £ materials 25.5 select 32 28) to/ o c i c v . t £ u t i l i z e vocational equipment £ materials 22.7 43 29) select £ u t i l i z e projective equipment £ materials 30.5 30) select £ u t i l i z e developmental equipment £ materials Data indicate number of respondents choosing 3 on scale of 3 referring to relevance Note:  4 5 10 6 11 19 17 8 3 2 9 18 13 20 23 15 22 27 21 14 12 16 6 9 17 23 25 26 24  Total Sample n = 176  Supervisors n = 37 Number % Response Sample  Rank  70.3 62.2 59.5 56.8 54.1 40 83 67 59 62 78.4 70.3 51.4 62.2 54..1 40..5 64..9 43..2 24..3 35..1 48.6 48.6 45.9 73.0 59.5 59.5 43.2 29.7 18.9 48.6  4 7 8 9 10 15 1 5 8 7 2 4 11 7 10 15 6 14 17 15 12 12 13 3 8 8 14 16 18 12  26 23 22 21 20 15 31 25 22 23 29 26 19 23 20 15 24 16 9 13 18 18 17 27 22 22 16 11 7 18  Number Response 121 109 98 106 95 71 148 108 100 119 135 103 80 95 74 59 93 62 36 65 88 91 84 112 99 87 60 47 38 60  "T Sample Rank 68. 61. 55. 59. 53. 40.2 83.2 60.9 56.4 67.0 76.0 58.1 45.3 53.6 41.9 33.5 52.5 34.6 20.1 36.9 49.7 51.4 47.5 63..1 55..9 49..2 34..1 26.8 21.8 34.1  3 6 12 8 14 22 1 7 10 4 2 9 20 13 21 27 16 25 29 23 17 15 19 5 11 18 24 28 30 26  ot competency to Occupational Therapy.  oo 00  Table 9 Relevance of Competencies by Geographic C l a s s i f i c a t i o n  Occupational Therapy Competencies  identify £ evaluate motor function identify £ evaluate perceptual-motor s k i l l s identify £ evaluate sensory function observe £ record cognitive function identify £ evaluate leisure £ play s k i l l s identify £ evaluate vocational s k i l l s identify 6 evaluate A.D.L, s k i l l s identify £ evaluate functional communicational s k i l l s identify £ evaluate psychosocial function conduct therapeutic interviews select £ adopt a c t i v i t i e s f o r therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop perceptual motor s k i l l s employ joint mobilization £ protection techniques employ muscle strengthening techniques t r a i n i n work simplification £ energy conservation techniques employ behavior modification approaches employ socio-drama techniques employ relaxation techniques employ r e a l i t y orientation employ activation methods u t i l i z e recreation £ leisure time a c t i v i t i e s select £ u t i l i z e s e l f care equipment £ materials select £ u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select 6 u t i l i z e avocational equipment £ materials select £ u t i l i z e vocational equipment £ materials select £ u t i l i z e projective equipment £ materials select £ u t i l i z e developmental equipment £ materials  Urban n = 136 Number '• 5 Response Sample 92 80 71 82 73 58 111 80 76 92 101 77 60 70 56 47 70 43 25 48 68 69 68 85 74 61 53 40 28 42  67.6 58.8 52.2 60.3 53.7 42.6 81.6 58.8 55.9 67.6 74.3 56.6 44.1 51.5 41.2 34.6 51.5 31.6 18.4 35.3 50.0 50.7 50.0 62.5 54.4 44.9 39.0 29.4 20.6 30.9  Rank 3 6 11 5 10 17 1 6  8  3 2 7 16 12 18 21 12 22 26 20 14 13 14 4 9 15 19 24 25 23  Rural n = 40 Number % Response Sample 27 27 25 23 21 12 35 26 22 25 32 24 19 23 18 12 21 18 11 17 19 21 16 25 23 24 6 6 10 18  67.5 67.5 62.5 57.5 52.5 30.0 87.5 65.0 55.0 62.5 80.0 60.0 47.5 57.5 45.0 30.0 52.5 45.0 27.5 42.5 47.5 52.5 40.0 62.5 57.5 60.0 15.0 15.0 25.0 45.0  Rank 3 3 5 7 9 14 1 4 8 5 2 6 10 7 11 14 9 11 15 12 10  9  13 5 7 6 17 17 16 11  Total Sample n = 176 Number % Response Sample Rank 119 107 96 105 94 70 146 106 98 117 133 101 79 93 74 59 91 61 36 65 88 90 84 100 97 85 59 46 38 60  68.2 61.5 55.3  59.8 53.6  40.2 83.2 60.9 56.4 67.0 76.0 58.1 45.3 53.6  41.9 33.5 52.5 34.6 20.1  36.9  49.7  51.4  47.5  63.1 55.9 49.2 34.1  26.8 21.8 34.1  3 6 12  8 14 22 1 7  10 4 2 9 20 13 21 27 16 25 29 23 17 15 19 5  11 18 24 28 30 26  Note: Data indicate nunber of respondents choosing 3 on scale of 3 referring to relevance of competency to Occupational Therapy.  CO  90  among t h e r a p i s t s r e d u c i n g ambiguous, therapy.  a  common  It i s  competencies  issue  of  tendency  phenomena  interesting are  occupational  the  those  in  to  field  of  the  the  be  occupational relevant to  the  physiotherapist.  The  ibe  may  to  most  relatively to  identity  terminology  that  are  compared  professional  the  note  that  t h e r a p i s t as  for  unique  reflected  in  these  results. A  comparison  competency  areas  of  the  according  respondent  r e v e a l s only  clinicians  and  the  competencies  five  ranked  relevant than highly  of  by  15%  less  of  than  equipment,  Three  relevance  relevant  of  the  training  developmental clinician's  top as  the role  for  w h i c h was  number of  as  although  15%  competencies work  greater  differed  in  special  and  utilizing  as more r e l e v a n t therapy  i t as  were r a n k e d among  simplification,  p r a c t i c e in occupational  Of  more  ranking  areas  they  by  studied. Adapting  were p e r c e i v e d  by  and  considered  respondents  by  the  held  selection  suggested  competency  of  r e l e v a n t , a l l were  except  supervisors  30  competencies.  most  other  in  equipment  ranked  equipment  d i f f e r e n c e i n the  relevant.  professional  groups  self-care  of  d i f f e r e n c e s in perceptions  i n the  two  relevance  the  perceived  the  clinicians  perception the  by  to  minor  supervisors  similarily  utilization  perceived  by  to  the  clinicians  than  supervisors. The  distribution  location of  are  relevance  therapists  reported of  is  competencies,  of c o m p e t e n c i e s  the  30  in Table  9.  competencies  indicated evaluation  in of  the  according  The  similarity  held  by  results.  activities  to  of  The  daily  of  urban three  geographic perception and  rural  top  ranked  living,  adapting  91  activities function  for therapeutic purposes,  are  the  competency groups.  same f o r b o t h  areas  Rural  function,  therapists  a i d s as  therapy  than  in  provided  more  the  total  needs  by  For  instance  of  training  practise  should  their be  of  training  available"  competencies  at  training which and  techniques, The  if are  practice  Only  three  of  two  sensory  and  selection  of  occupational  both high,  of  to  total  55%  of  to  relation total  of  the  highest  evaluate  and  11  equipment identify results  and and  and  clearly  vocationally-oriented  current  represent  the  sample w h i c h c h o o s e t h e  "no  the  The  30  competencies.  revealed  that  on  t h e r a p i s t s stated that  skills,  materials, materials,  evaluate  and  therapists  area.  a  five  follows:  and  utilize  select  and  utilize  employ play  lack  c o m p e t e n c i e s . T h i s may  there  select  l e i s u r e and  indicate  all  The  mean r e s p o n s e s were as  vocational  equipment  the  occupational  o p p o r t u n i t i e s a v a i l a b l e i n the  had  program  need e s t i m a t e  quality  sample the  30  in  10  of  the  information  the  Tables  responses  least  the  in  to supplement  the  to  percent  t o the  opportunities  in order  utility  r e s p o n s e and  in r e l a t i o n  vocational  to  estimate  assessed.  frequency  avocational  evaluation  training  assessed  or  identify  of  was  programs  areas  motor  of T r a i n i n g O p p o r t u n i t i e s  availablity  were no  respondents.  simplification,  relevant  areas  planning.  results  perceived  work  availability  competency  g r o u p s of  of  d i d urban t h e r a p i s t s .  Availability The  evaluation  r e v e a l e d m a j o r d i s c r e p a n c i e s between t h e s e  training  mobility  and  be  of  socio-drama skills. training  partially  in  Table 10 Perceived A v a i l a b i l i t y of Training by Professional Role  Occupational Therapy Competencies  1) 2) 3) 4) 5) 6) 7) 8) 9) 10) .11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30)  identify £ evaluate motor function identify £ evaluate perceptual-motor s k i l l s identify £ evaluate sensory function observe £ record cognitive function identify £ evaluate leisure £ play s k i l l s identify £ evaluate vocational s k i l l s identify £ evaluate A.D.L. s k i l l s identify £ evaluate functional ccmmunicational s k i l l s identify £ evaluate psychosocial function conduct therapeutic interviews select E adopt a c t i v i t i e s far therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop p>erceptuai motor s k i l l s employ j o i n t mobilization E protection techniques employ muscle strengthening techniques t r a i n i n work simplification £ energy conservation techniques employ behavior modification approaches employ socio-drama techniques employ relaxation techniques employ r e a l i t y orientation employ activation methods u t i l i z e recreation £ leisure time a c t i v i t i e s select £ u t i l i z e s e l f care equipment £ materials select £ u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select £ u t i l i z e avocational equipment £ materials select £ u t i l i z e vocational equipment £ materials select £ u t i l i z e projective equipment £ materials select E u t i l i z e developmental equipment £ materials  Note:  Clinicians n = 139 Number 5 Response Sample 82 87 93 103 101 110 80 89 96 94 94 94 93 76 83 86 88 89 105 88 89 91 87 84 86 87 102 102 99 101  58.2 61.7 66.0 73.0 71.6 78.0 56.7 63.1 68.1 66.7 66.7 66.7 66.0 53.9 58.9 61.0 62.4 63.1 74.5 62.4 63.1 64.5 61.7 59.6 61.0 61.7 72.3 72.3 70.2 71.6  Rank 17 13 9 3 5 1 18 11 7 8 8 8 9 19 16 14 12 11 2 11 12 10 13 15 14 13 4 4 6 5  Supervisors n = 37 Number ? Response Sample 16 22 22 27 30 31 22 21 22 22 25 26 23 18 22 23 27 25 27 22 24 25 23 23 24 23 30 27 26 29  43.2 59.5 59.5 73.0 81.1 83.8 59.5 56.8 59.5 59.5 67.6 70.3 62.2 48.6 59.5 62.2 73.0 67.6 73.0 59.5 64.9 67.6 62.2 62.2 65.9 62.9 81.1 73.0 70.3 78.4  Rank  Total Sample n = 176 Number ? Response Sample Rank  11 9 9 4 2 1 9 10 9 9 6 5 8 10 8 8 4 6 4 9 7 6 8 8 7 8 2 4 5 3  98 109 115 130 131 141 102 110 118 116 119 120 116 94 105 109 115 114 132 110 113 116 110 107 110 110 132 129 125 130  54.7 60.9 64.2 73.9 73.7 79.3 57.0 61.5 65.9 64.8 67.0 . 67.0 64.8 52.5 58.7 60.9 64.2 64.2 74.3 61.5 63.7 64.8 62.0 59.8 61.5 61.5 73.7 72.6 70.4 72.6  18 14 10 4 3 1 17 13 8 9 7 7 8 19 16 13 10 10 2 12 11 9 12 15 13 13 3 5 6 5  Data indicate number of respondents stating training opportunities are presently available i n t h i s competency area.  vO to.  Table 11 Perceived A v a i l a b i l i t y of Training by Geographic C l a s s i f i c a t i o n  Occupational Therapy Competencies  1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30)  identify £ evaluate motor function identify £ evaluate perceptual-motor s k i l l s identify £ evaluate sensory function observe £ record cognitive function identify £ evaluate leisure £ play s k i l l s identify £ evaluate vocational s k i l l s identify £ evaluate A.D.L. s k i l l s identify £ evaluate functional communicational s k i l l s identify £ evaluate psychosocial function conduct therapeutic interviews select £ adopt a c t i v i t i e s f a r therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop perceptual motor s k i l l s employ joint mobilization £ protection techniques employ muscle strengthening techniques t r a i n i n work simplification £ energy conservation techniques employ behavior modification approaches employ socio-drama techniques employ relaxation techniques employ r e a l i t y orientation employ activation methods u t i l i z e recreation E leisure time a c t i v i t i e s select £ u t i l i z e s e l f care equipment E materials select E u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select £ u t i l i z e avocational equipment £ materials select £ u t i l i z e vocational equipment £ materials select E u t i l i z e projective equipment £ materials select E u t i l i z e developmental equipment £ materials  Note:  Data i n d i c a t e number o f r e s p o n d e n t s s t a t i n g t r a i n i n g  Urban n = 136 % Number Response Sample 68 74 81 94 94 103 69 74 85 80 83 87 85 62 75 78 84 80 97 77 80 82 77 74 77 75 96 94 90 94  50.0 54.4 59.6 69.1 69.1 75.7 50.7 54.4 62.5 58.8 61.0 64.0 62.5 45.6 55.1 57.4 61.8 58.8 71.3 56.6 58.8 60.3 56.6 54.4 56.6 55.1 70.6 69.1 66.2 69.1  Rural n = 33  %  Rank  Number Response  Sample  Rank  18 16 11 4 4 1 17 16 7 12 9 6 7 19 15 13 8 12 2 14 12 10 14 16 14 15 3 4 5 4  28 33 32 34 35 36 31 34 31 34 34 31 29 30 28 29 29 32 33 31 31 32 31 31 31 33 34 33 33 34  70.0 82.5 80.0 85.0 87.5 90.0 77.5 85.0 77.5 85.0 85.0 77.5 72.5 75.0 70.0 72.5 72.5 80.0 82.5 77.5 77.5 80.0 77.5 77.5 77.5 82.5 85.0 82.5 82.5 85.0  9 4 5 3 2 1 6 3 6 3 3 6 8 7 9 8 8 5 4 6 6 5 6 6 6 4 3 4 4 13  Total Sample n = 176 Number % Response Sample Rank 96 107 113 128 129 139 100 108 116 114 117 118 114 92 103 107 113 112 130 108 111 114 108 105 108 108 130 127 123 128  54.7 60.9 64.2 73.9 73.7 79.3 57.0 61.5 65.9 64.8 67.0 67.0 64.8 52.5 58.7 60.9 64.2 64.2 74.3 61.5 63.7 64.8 62.0 59.8 61.5 61.5 73.7 72.6 70.4 72.6  o p p o r t u n i t i e s are p r e s e n t l y a v a i l a b l e i n t h i s competency  18 14 10 4 3 1 17 13 8 9 7 7 8 19 16 13 10 10 2 12 11 9 12 15 13 13 3 S 6 5 area  U3  co  94  explained  by t h e f a c t  treatment  are  emphasized  either  Again,  the  comparison absence  within  of  training where  program  extent their  respondent, of  considered  analyzed  there  clinicians  therapists  in relation  functional  communication  perception  of  the  and  urban  as  an a r e a  continuing groups,  lack  therapists. of  was an a r e a  shared  may n o t be a d e q u a t e t o  of  training  to professional  r o l e of  between  both  urban  and  of v o c a t i o n a l l y - r e l a t e d  in perceptions  were n o t e d i n  therapists  behavior  competencies,  perceived  m o d i f i c a t i o n , and  less  Similar  opportunity  to the  t h e r a p i s t s more o f t e n  for  differences  in  evaluation  of  o f major d i f f e r e n c e between  training i s lacking.  the  When t h e sample was  location  as a r e a s h a v i n g  therapists, rural i n which  the  areas of  professional  discrepancies  Rural  interviews,  relevance  function  in  occupational  Frequently.a  and s u p e r v i s o r s .  areas.  therapeutic  urban  and  availability  emphasized  competency  than  those  to the  to geographic  conducting  training  are  programs.  p r o g r a m s a l t h o u g h major d i f f e r e n c e s other  emphasized  education  were no major  in relation  training.  work i n a r e a s n o t  physiotherapists  pertaining  was  f o r both  i t i s not  The a r e a s where  noticable  t h e r a p i s t s that  own c o n t i n u i n g  opportunities  sensory  were  and  and knowledge common t o b o t h . The s m a l l  with  When t h e d a t a  perceptions  most  offered  on t h e s k i l l s  some  four  undergraduate  do n o t o v e r l a p .  of o c c u p a t i o n a l  rural  or  physiotherapists'  is  evaluation  mandate o f t h e t h e r a p i s t ,  competencies  is  activities  focussing  support  vocational  to the p h y s i c a l l y r e l a t e d areas.  education  the  the  psychosocial  therapists'  to  although  i n the l i t e r a t u r e  rehabilitation  number  that  rural  identifying i t  95  Barriers  The are  therapists' perceptions  presented  in Tables  total  sample as  were  identified  their  importance,  programs, as  lack  p r o g r a m s . The suitable  high  despite  the  education  13.  estimate  of  importance,  more o f t e n family  The  perceive  i n her  study.  lack  of  role  of  as  lack  of  It  is of  order  a major  the  data that  attending  education lack was  to  that  continuing  interest  groups,  organizations,  programs  of  ranked  note  groups o f f e r i n g  professional  of  identified  suggested  special  the  appropriate  were  interesting  and  the  to  be  continues  b a r r i e r to p a r t i c i p a t i o n . in  both  responsibilities  and  also  of  barriers  o n e s . In  b a r r i e r , however, c o s t  however, p e r c e i v e d  responsibility  geographic  study  including  as  revealed  to c l i n i c i a n s  was  situational  responsibilities  appropriate  identified  family  appropriate  participation  mean r a n k i n g  institutional  numbers  national  b a r r i e r more o f t e n  distance  job  a major  increasing  Supervisors,  the  responsibility,  (Note 5)  as  analysis  professional  Using  to  b a r r i e r s to p a r t i c i p a t i o n in c o n t i n u i n g  and  consistently  As  than  t i m e , and  McGregor  universities,  barriers  an  opportunities,  provincial  of  12  programs  equally  a  an  of  the . major  barriers  to P a r t i c i p a t i o n  respect  to  supervisors and  lack  continung lack  than  clinicians  cost  were  of  and  of  clinicians  t i m e as  education  major  programs.  appropriate  who  greater  respondent's  indicated  programs  as  that  job  deterrents  than  lack  perceived  barriers  of  programs. expected, location the  top  the  breakdown  revealed  that  of  rural  therapists  b a r r i e r to p a r t i c i p a t i o n , with  15  by  ranked  rural  Table 12 Ranking Perceived Barriers to Participation by Professional Role  Barriers  Total Sample n = 176  Supervisors n = 37  Clinicians n = 139  Situational  Barriers 2  2  1.60  24  6  10  1.65  7  3  2.08  19  20  17  1.96 1.97  Family responsibilities  18  4  8  1.67  6  Job responsibilities  17  13  14  1.93  2  Cost Distance  29  41  23  1.94  7  4  10  2.14  36  45  33  16  16  19  2.06  4  3  2  1.78  20  19  21  2.01  Lack of time  19  17  16  24  25  19  1.93  1  2  2  2.20  1.78  23  17  18  1.91  2.62  6  10  13  2.24  11  2.36  19  2.20  Transportation  1  2  2  1.94 2.20  5  8  3  1.87  0  0  0  0  Institutional Barriers No appropriate program available  16  15  14  1.96  Insufficient advance notice  6  7  8  2.09  Inadequate publicity  3  5  11  2.42  0  2.00  3  8  Inconvenient scheduling  5  11  12  2.25  2  2.00  7  13  0  l = number of times response ranked as 1st most frequently encountered terrier. 2 Z b e r of times response ranked as 2nd most frequently encountered barrier. 3 "= n l X r of S i s response ranked as 3rd most frequently encountered barrier.  a  :  mean rank with lower value signifying higher rank.  b  ON  Table 13 Ranking Perceived Barriers to Participation by Geographic Location  Urban n = 136  Barriers l  3  2  a  Rural n = HO X  3  2  1  Situational Family responsibilities  18  6  3  1.44  6  Total Sample ._ 3 2  1  X  X  Barriers  0  7  2.08  a  24  6  10  1.65  2.20  D  19  20  17  1.96  Job responsibilities  17  20  14  1.94  2  0  3  Cost  29  30  25  1.95  5  15  8  2.10  36  45  33  1.97  15  9  9  1.18°  20  19  21  2.01  24  25  19  1.92  1  2  2  2.20  Distance Lack of time Transportation  5 24 0  9 23 0  12 17 2  2.27 1.81  0  2  1  2.33  3.00  1  2  0  1.66  Institutional No appropriate program available  d  Barriers  20  11  15  1.89  3  5  3  2.00  23  17  18  1.91  Insufficient advance notice  4  8  11  2.30  2  2  2  2.00  6  10  13  2.24  Inadequate publicity  3  7  9  2.31  0  1  1  2.50  3  8  11  2.36  1  2  1.68  7  13  14  2.21  Inconvenient scheduling  6  11  14  2.25  0  e  ^ a u = .14 p < .05 ^ a u = -.20 p < .007 'TTau = .49 p < ,02 ^Taa = -.30 p < .003  ^Tau = .16 p < .03  vO  98  therapists compared ranked only  ranking  t o 5 urban  high five  barrier.  f r e q u e n t l y encountered  therapists.  Although  t h e r a p i s t s when mean r a n k s  therapists  i n the t o t a l  Urban  therapists  scheduling  ranked  barrier  transportation  among r u r a l  inconvenient rural  i t a s t h e most  a r e compared,  sample a c k n o w l e d g e d family  significantly  also  i t as a  responsibility  higher  than  and  did their  colleagues. It  would a p p e a r  from  these  results  the  program  that  i t i s the c h o i c e of  <»  topic  rather  therapists  than  perceive  planning  as a b a r r i e r  and n o t i c e a r e s u f f i c e n t l y  topic  relevant  flexible, third  and  participation  category  rationale respondent education  of  the  f o r not i n c l u d i n g indicated  that  because they  competence. T h i s  was  they  d i d not t h i n k  supports  the  Only  one  i t necessary  in continuing for continuing  t h e r e s e a r c h on d i s p o s i t i o n a l  suggesting  that  respondents  will  if  the  opportunity  on  given  and  presented.  were n o t i n t e r e s t e d  not s t a t e t h i s an open ended  the  Three, the  introduced  study  if  situation  In C h a p t e r  briefly  i t in this  that  personal  c o u l d be e x p e c t e d .  the  Scheduling,  well organized  therapist's  barrier  that  to p a r t i c i p a t i o n .  publicity, is  process  type  barriers  of  "other"  barrier item  on a  questionnaire.  Delivery  Continuing Those those and  delivery most  education  programs may t a k e  a variety  s y s t e m s t h a t were i n c l u d e d i n t h i s  often appearing  15 r e p r e s e n t  Systems  i n the r e l a t e d  the d i s t r i b u t i o n  of  study  literature.  forms. reflect  Tables  of p r e f e r r e d d e l i v e r y  14  system .  99  Considering as  direct  ranked  and  broad c a t e g o r i e s  distance,  higher  ranked 166  the  the  t h a n any  of  significantly  (95%)  of  the  preferences  of  reflect  the  utilized  in  distance  systems.  higher  t h a n any  other  ranking  that  with  few  comparison  to o t h e r s .  the  suitable  delivery  education  programs  most  continuing Table  14 p r e s e n t s  professional  role.  most p r e f e r r e d by supervisors  preferred  most  short  Considering geographic  most  programs  relatively rural  courses  more t h a n  s t a t e of  therapists  often  rural  are  of  l a c k of  an  three may  preference  subject  a in  workshop matter  as  results  is in  travelling  while  clinicians  in r e l a t i o n  prefer This  in B r i t i s h  indicated  unexpected with  for  the  travelling reflects  the  since  areas,  urban  consultants.  distance  result  to  Columbia  metropolitan  for t r a v e l l i n g  familiarity  system  choice.  education  need  the  to  i n d i c a t e that  preferring  urban c o l l e a g u e s .  in  according  workshops as  therapists  offered  preference  t h e r a p i s t s was  indication  f o r the  p r e f e r r e d d e l i v e r y systems  continuing  top  illustrated  the  workshops  a second  their  with  for t h e r a p i s t s .  after  would have l e s s low  system  t h e r a p i s t s . The  as  system  the  a  i s because  clinicians  location,  consultants present  clinical  were  f o r workshops  than  Both groups p e r c e i v e d  the  of  p r e f e r r e d d e l i v e r y systems  perceive  consultants  of  resultsmay  rather  Perhaps t h i s  s y s t e m s were  d e l i v e r y s y s t e m s have been  the  system  one  study  Workshops  type  preference  other  Columbia,  this  i t as  in t h i s  direct  the  d e l i v e r y s y s t e m . The  British  systems used  f o u r examples o f  respondents  fact  familiarity  of  which  The  systems may  systems s t u d i e d  be or  by an of  Table 14 Ranking Preferred Delivery Systems f o r by Professional Role  Clinicals n = 139  Delivery System l  a  2  3  Supervisors n = 37 -b X  1  2  3  T o t a l Sample n = 176  x  1  2  3  X  Direct Systems 1 or 2 day workshops  99  20  12  1.33  29  4  2  1.23  128  24  14  1.31  Short courses  11  31  23  2.19  0  7  8  2.53  11  38  31  2.25  Evening series  8  35  22  2.21  3  7  7  2.24  11  42  29  2.20  Travelling consult.  8  25  20  2.23  2  9  5  2.19  10  34  25  2.22  Distance Systems Audio tapes  1  7  18  2.65  1 3  6  2.50  2  10  24  2.61  Educational t.v.  7  11  25  2.42  1 4  4  2.33  8  15  29  2.40  Educational radio  0  2  0  2.00  0  0  1  3.00  0  1  1  2.50  Correspondence  1  2  9  2.67  0  0  0  0.00  1  2  9  2.67  = number of times response ranked 1st most preferred. 2 = number of times response ranked 2nd most preferred. 3 = number of times response ranked 3rd most preferred. mean rank with lower value s i g n i f y i n g greater preference.  Table 15 Ranking Preferred Delivery Systems i n by Geographic Location  Urban n = 136 2 3  Delivery System I  6 1  W~  I  Rural n = 40 5~~3  T o t a l Sample n = 176 x~~' "1 2~1 X  Direct Systems 1 or 2 day workshops Short courses Evening series T r a v e l l i n g consult.  128  24  14  1.31  11  38  31  2.25  11  42  29  2.20  1.85  10  34  25  2.21  102  17  10  1.29  24  7  4  1.43  8  27  26  2.29  3  10  5  2.11  11  38  22  2.16  0  4  6  2.60  3  25  20  2.35  7  9  4  a  Distance Systems Audio tapes  2  8  7  2.56  0  2  7  2.78  2  10  24  2.61  Educational t.v.  4  9  22  2.51  4  5  7  2.18  8  15  29  2.40  Educational radio  0  1  1  2.50  0  0  0  0.00  0  1  1  2.50  Correspondence  1  2  6  2.55  0  0  3  3.00  1  2  9  2.67  ^au  = -.17 p < .02  102  the  skepticism  introduced  of  for  the  respondents  continuing  that  education  such  s y s t e m s would  purposes  in  be  British  Columbia. Because the  the  to  to  conditions, applied  availability the  therapists  delivered  Forty-five  therapy  Although  planning,  -because  questionable  of  hypotheses  were c o n s i d e r e d learning  r o l e and  delivery  maintained  in  the  perception  clinical  of  specifically  favored  27.3%  and  13.4%  results  included  programs  to  clinical  to basic  indicate  the  marginal  system,  valuable  preference  the  and  major  t o p i c , which would be of  in  by  information  Hypotheses  of  in  this  continuing  geographic three  perceived  to  p<.05 l e v e l the  1 stated:  There w i l l  be  t h e r a p i s t s and  a  of  on  result  differences variables  participation, significance  and was  hypotheses. a  significant difference  therapi sts' learning  s u p e r v i sory  as  program p l a n n i n g  t e s t i n g of  clinical  focused  l o c a t i o n . These  the  of  study  education  barriers  s y s t e m s . The  throughout  Hypothesis  sample  issues,  a delivery  in r e l a t i o n to  needs,  preferred  the  skills,  examined  in perceptions  professional  item  value.  Tests  differences  t e l e v i s i o n with  t e l e v i s i o n was  the  p r e f e r e n c e s of  f o r t e l e v i s o n as  The  of  to p r o f e s s i o n a l  i n the  educational  via  percent  occupational  sciences.  program  of  Knowledge Network, an  t o be  14%  differences  of  of  topics  study.  related  is  the  introduction  related  in  of  therapi sts.  needs  between  1 03  A comparison needs out  held  on  the  of p e r c e p t i o n  by  clinical  30  competency  of c l i n i c a l  and s u p e r v i s o r y areas  of competency: e v a l u a t i o n ,  utilizing  therapeutic  the  means of  competency was  the  significant,  the  motor  means  of  significant therapists.  apply  skills the  categories between  B a s e d on t h e s e 2 stated:  ident i f i c a t ion  Differences  barriers  studied.  also  no  2 was  Hypothesis the  therapies  perceived  Using the  therapists.  held  groups develop  of c o m p e t e n c i e s  showed no  and  supervisory  1 was  rejected.  be s i g n i f i c a n t d i f f e r e n c e s clinical  barriers in  were each  of the K e n d a l l  differences.  The  assessed of  the  Tau f o r ranked two  by  eight data  categories  institutional,  of  were  a C h i S q u a r e , no s i g n i f i c a n t d i f f e r e n c e s two  groups.  Based  on  these  results,  rejected. 3 stated:  perception  therapists  to  one  compared,  r e s u l t s , Hypothesis  Comparision  were f o u n d between  in  the t h e r a p i s t  t o p a r t i c i p a t i o n , s i t u a t i o n a l and  Hypothesis  only  therapi sts.  significant  compared.  A comparison of  p<.04). When  t h e two g r o u p s of t h e r a p i s t s  revealed barriers  in  three  p r o c e d u r e , and  revealed  clinical  There w i l l  the  of b a r r i e r s t o p a r t i c i p a t i o n between  t h e r a p i s t s and s u p e r v i s o r y  comparing  based  ( t=2.03, df=17 5,  differences  Hypothesis  between  learning  was c a r r i e d  on  therapeutic  competencies  sensory  three  and  and m a t e r i a l s .  i n which the d i f f e r e n c e  perceptual  in  individual  therapists  studied  categories  equipment  therapists'  by  of  There w i l l delivery  clinical  be a s i g n i f i c a n t d i f f e r e n c e  systems p r e f e r r e d therapists  and  by  clinical  supervisory  104  A  comparison  g r o u p s of  systems,  Tau  between t h e comparing  groups the  A  needs  30  of  the  between  two  the  technique  the  of  of  using  significant difference A  Chi  f o r d i r e c t and  Square distance  Based  signi f icant  rural  upon  d i f ferences  clinical  areas  needs was  therapi sts  therapeutic  t = - 1 .99  categories  g r o u p s . Based on consideration  comparison reveals these of  revealed  no  of  were  learning  the  in  two  competency  two  different  orientation higher  was  areas  t= -  among  i n the  significant differences 4  An  socio-drama  needs  r e s u l t s , Hypothesis  the  materials. that  reality  needs  as  on  therapeutic  (employing  p< . 0-5 , employ  both c a s e s the  A  and  both  well  were s i g n i f i c a n t l y  therapists  df = 1 36  as  evaluation,  equipment  needs  of  conducted  investigated  competencies,  groups  therapists.  competency  comparison  differences.  be  learning  learning  d f = l 3 6 p<.03). In  rural  individual  larger categories  studied.  i n d i v i d u a l competencies  areas  with  of  utilizing  competency  two  rejected.  i d e n t i f i e d by  categories  analysis  f o r the  eight  A  no  There w i l l  i n d i v i d u a l competency  p r o c e d u r e , and  systems.  significant 3 was  the  two  systems  systems  therapi sts.  comparison  three  the  no  the  in preference  4 stated:  clinical  on  revealed  eight  differences  learning  urban  2.15  i n the  r e s u l t s , Hypothesis  the  b o t h on  distance  revealed  delivery  conducted  ranked data  Hypothesis  the  was  and  for  systems a l s o  and  preferred  d e l i v e r y s y s t e m s and direct  Kendall's  in  the  therapists  examples o f  these  of  three  between rejected  that  were  statistically significant. Hypothesis significantly  5 stated: higher  rural clinical  estimate  of  therapi sts w i l l  learning  have  needs t h a n do  a  urban  105  clinical  therapi sts.  A comparison using  T-Tests  significant expressed  to  differences  5 was  Hypothesis barr i e r s  between  6 stated:  to  There w i l l  barriers.  The  analysis  of  Tau f o r ranked d a t a groups  in  schedule urban  lack  of  reveals  while  a significant  6 was n o t r e j e c t e d .  A  barriers'  significant  using  differences  j o b r e s p o n s i b i l i t y (Tau=-.20 p<.003),  relationship  there  and  will  Based  inconvenient  higher  o f s i t u a t i o n a l and  p<.01).  systems p r e f e r r e d  urban c l i n i c a l  institutional  significantly  Hypothesis  delivery  and t h e two  and  individual  both  (Tau=.49 p<.02) were  A comparison  7 stated:  study  on  responsibilty  (Chi=5.9l  Hypothesis  clinical  Family  analysis  in  this  barriers.  (Tau=-.30  df=7  rural  conducted  (Tau=-.16 p<.03) were s i g n i f i c a n t l y  therapist.  barriers  by  barriers  the  five  time  in  revealed  among r u r a l t h e r a p i s t s  p<.007),  need  be a s i g n i f i c a n t d i f f e r e n c e  b a r r i e r s was  situational  (Tau=.l4 p<.05) and d i s t a n c e higher  of  no  therapi sts.  investigated  proposed,  the  statement  ident i f ied  of p e r c e i v e d  categories  between  sample  i n t h e means r e v e a l e d  the general  part i c i p a t ion  barriers  Kendall's  the  rejected.  A comparison eight  of  t h e r a p i s t s . Based on t h e s e r e s u l t s ,  t h e r a p i s t s and urban c l i n i c a l  the  estimates  analyze d i f f e r e n c e s  by r u r a l and urban  Hypothesis  in  of t h e summed need  the  institutional  using on  among  Chi  these  Square  results,  be a s i g n i f i c a n t d i f f e r e n c e  by r u r a l c l i n i c a l  therapi sts  and  therapi sts.  comparison  of d e l i v e r y  s y s t e m s was c o n d u c t e d  b o t h on t h e  106  eight  systems  proposed  direct  individual  and  distance  systems.  Kendall's  differences  between  system. Evening  more  by  .02).  The c o m p a r i s o n  urban  significant results,  i n t h i s s t u d y and t h e two  systems u s i n g  significant delivery  investigated  series  therapists  significant  than  preferred  currently  practising in British  136 r e s p o n d e n t s were c l i n i c a l therapists.  Seventy-eight  departments  of f i v e  were c l a s s i f i e d  therapists.  The  professional  contacts  were  supervisors  were  reported  were  no  o f t h e one  presented  while  as urban  therapists sample,  supervisory  Geographically,  therapists had  estimate  139  d i d urban  fewer ones.  needs, b a r r i e r s t o  sytems h e l d  minimal. Evaluation highest  than  had a  and 37 a s r u r a l  significantly  of l e a r n i n g  delivery  therapists  the s u p e r v i s o r s  therapists  perception  t o have t h e  this  o f t h e sample were employed i n  t h e r a p i s t s . The c l i n i c a l  with other  in  total  t h e r a p i s t s and 40 were  therapists  and p r e f e r r e d  and  revealed  176 o c c u p a t i o n a l  of e x p e r i e n c e  respondents  participation,  (Tau=-.17 p<  two g r o u p s . Based on t h e  C o l u m b i a . Of t h e  percent  o r fewer  in  significantly  systems  mean o f 10.42 y e a r s o f r e l a t e d e x p e r i e n c e .  Differences  one  Results  sample c o n s i s t e d  rural  reveals  i n only  with consideration  analyses  The s t u d y  years  groups  the  found.  r e s u l t s of t h e d a t a  6.75  of  data  rural therapists  7 was r e j e c t e d  chapter.  averaged  two  were  Summary o r  The  the  between t h e s e  relationship  analysis  Tau f o r ranked  o f d i r e c t and d i s t a n c e  differences  Hypothesis  An  categories  by  related of  clinicians competencies  learning  need  1 07  while  the  competency  available  was  clinicians lack  of  were  and  t i m e as  their  relation A  and for  the  to  hypothesized  have  continuing Columbia.  therapists  Both  responsibility  and  Workshops  both ' sub-samples  program  in  therapists.  revealed of  the  the  differences  learning  to  those  The  needs  reported  analysis  significant differences  therapist; and  major  barriers  based  rural therapists distance to  be  of  and  more urban  inconvenient  responsibilty. results  relationships information  implications education  variables  significant  in r e l a t i o n to  transportation  the  no  planning  r e s u l t s were s i m i l a r  location  program p l a n n i n g  of  programs  treatment.  participation.  revealed  supervisory  family  Although  will  urban  reported  and  to  three  study  participation  therapists  and  preference  the  this  identified  training  systems.  and  geographic  schedule  barriers  s y s t e m s . The  clinical  often  major  of  r u r a l and  barriers on  i d e n t i f i e d family  in  delivery  fewest  supervisors  delivery  investigated  the  assessment  overwhelming  to  with  vocational  comparison  between  area  for  did  not  between was  support the  gained  both  opportunities  long  and  for  many  of  sub-samples, from short  the  the  valuable  study  which  term p l a n n i n g  therapists  in  of  British  108  CHAPTER  FIVE  DISCUSSION AND  The  primary  relationships of  assist clinical  barriers  the  design  results  of  the  in  the  needs  by  clinical  held  perceived  learning  Evaluationof  geographic  participation, to gather  education  greatest  need-  continuing  education  these  relation  differences  The  study  in  found  of  to  opportunities  for  no  between  therapists  urban and  notably  rural  of  to  that  in  being  the  cognitive,  and  availability  of  opportunities  held  significant,  participation,  by  clinicians  for  higher  significant  responsibility  among identified  and  although supervisors  d i f f e r e n c e s between u r b a n  were s t a t i s t i c a l l y  t h e r a p i s t s more o f t e n  the  or  therapists.  as  perceptual,  confirmed  b a r r i e r s s t u d i e d . Family  significantly  significant  clinical therapists'learning  supervisory  barriers  perception  therapists  preferred  are l i m i t e d .  to  t o be  variables:  information  revealed  assessment  areas  the  location  and  r e l a t e d c o m p e t e n c i e s were i d e n t i f i e d  in  eight  t o examine  Columbia.  and  needs  programs  rural  to  perception  evaluation.  were not  was  program p l a n n i n g  of c o n t i n u i n g  differences  In  three  therapists in B r i t i s h  The  sensory  study  s y s t e m s . A s e c o n d p u r p o s e was in  areas  this  t h e r a p i s t s and  needs,  delivery  of  between p r o f e s s i o n a l r o l e and  occupational  learning  purpose  CONCLUSIONS  rural job  and  therapists  on  five  and  of  distance while  responsibilities,  the were  urban  time,  and  109  inconvenient continuing  scheduling  education  Workshops  were  the  in r e l a t i o n  preferred  delivery and  significantly This the  the  provided  with  introduction identified control  of  the  implications as  a major  list  is  upon  supervisory needs and  was  by  to  which  appropriate  identified support  received  along  regarding barriers  often has  the were  beyond  more  programs was  the  direct reported  barrier.  R o l e and  r o l e was i n the  Continuing  examined  Education  in t h i s  continuing  hypothesized  tendency  which  to  British  well,  situational  of  of  relevant  was As  t h e r a p i s t s , they are  lack  between preferred  is highly  base d e c i s i o n s  that  of  therapists.  areas  finding  consult  were  term p l a n n i n g .  to  all  analysis  for therapists in  A  therapists  the  rural  planner.  preferences  b e c a u s e of therapy  which  often  decision-making It  in  of  differences  u s e d d e l i v e r y s y s t e m was  institutional  Professional  process.  than  competency  long  The  series  education  of  and  Professional  to  urban  newer o n e s . A l t h o u g h  more  of  by  preference  no  Evening  information  frequently  information  participation  systems.  revealed  continuing  immediate  most  delivery  systems  Columbia. A p r i o r i z e d  for  to  more o f t e n  p r o v i s i o n of  to  overwhelming  clinicians.  study  permitting  barriers  programs.  subsamples  supervisors  as  study  education  that  clinical  would have d i f f e r e n t clinicians. for  program  supervisors  This  it  related  program  planning  therapists  perceptions  p r o b l e m was  planners  about  as  the  in  of  focused  and the on  occupational  continuing  education  110  needs and p r e f e r e n c e s to  of t h e i r  representatives  that  of c l i n i c a l  B r i t i s h Columbian  similar  in their  explanation  staff  rather  t h e r a p i s t s . The  supervisors  perceptions  and  directly  results  clinicians  i n the three  f o r the s i m i l a r i t y  than g o i n g  suggest  are  fairly  variables studied.  of p e r c e p t i o n  is likely  that  majority  of s u p e r v i s o r y  t h e r a p i s t s sampled a r e  responsible  only  small  of s t a f f .  with  a  enable  the s u p e r v i s o r y  staff's of  number  perceptions  t h e r a p i s t s to  in these  the groups i n regard  having  similar  Learning  areas.  perceptions supervisors learning  this  of c l i n i c a l  aware  would  of  their  similarity  may  have  led  suggest  that  there  differences  to  are high.  attribute  these  experience  the s u p e r v i s o r this  In c o n t r a s t ,  results  in  their  has had  years  of  their  in  presented  of  not  of  of  explanation  f o r the c o n s i s t e n c y  found  experience  as  a  to  be  which i n the  exist  and  amount of  health  care.  of p e r c e p t i o n result  and e x p o s u r e t o t h e h e a l t h c a r e  i f c l i n i c i a n s and s u p e r v i s o r s have  of  years  significant.  between  no  self-  d i d r e v e a l a mean d i f f e r e n c e o f 3.5  similarity  differ  areas  t o the g r e a t e r  i n the f i e l d  are  the  perceptions  differences, in part,  t h e g r o u p s i t was  perceptions  of competency  that d i f f e r e n c e s  study  between  t h e r a p i s t s and t h e p e r c e p t i o n s  i n the i d e n t i f i c a t i o n  needs  Although  study  significant  suggest  that  more  staff  In a d d i t i o n , t h e  to experience  literature  practise  be  for  perceptions.  of  statistically  If  contact  the  Needs  Results  between  Close  The  The  t h e g r o u p s i s one of l e a r n i n g  increasing  field,  years  one would  comparable  need. of  expect  amounts  of  111  experience,  differences in perceptions  m i n i m a l as  was  the  Examining relationship of  the  many the  was  field  based The  of  numbers t h a t  Columbia  has  it  background,  types  of  the  of  involved  each  may  possible  that  of employment role  be  found of  studies  learning be  experience  educational  An  and  considered  additional  difference  in  differences therapy  in  their  experience  areas.  this  the  Although  number  training  of  is  far  nursing,  are  notably Nurses British  approximately  marked in  and  in  all  educational  stratification  among n u r s e s  f o r the  than  results  that  differences  in  in Chapter  homogeneous  these  supervisors;  their  Four,  in  work  two  this  Supervisors  groups  would in  is  the  lead  to  occcupational  p o s i t i o n s through accumulating  i n one  is often  graduate  courses  between  perceptions.  number of y e a r s  and  background.  of  frequently obtain  as  mentioned  relatively  drawn  and  the  has  greater  As  difference  training  be  account  was  Registered  investigating  needs.  t h e r a p i s t s may  therapy  situations,  may  results  philosophy  differences  have  perception  the  the  not  These d i f f e r e n c e s c o u l d in  literature  Therapists  therapists. been  the  22,000 members w h i l e  Occupational  professional  be  hypothesized  profession  Columbia,  difference  is  the  explaining  supporting  in  approxiamtely  locations,  which  in occupational  British  this  upon  A l t h o u g h much of  similar  of  l e a r n i n g need would  study.  method of  majority  are  Society  Although  i s one  nursing.  In  Association  in this  literature  p r a c t i s e s are  different.  300.  the  study.  from t h e  case  of  the  l o c a t i o n or case with  programs greater  in  related  nursing  nursing  than  and  a  speciality  supervisors, supervisor  that a v a i l a b l e to  the  112  therapist.  Supervisors  educational staff  for  therapists  are  of  the  therapists  of  by  the  less.  supervisors  staff  in  a  number of  supervisors  the  with  opportunity  size  learning  based  of  this  to  the  and  need  that  to  five would  of  their  including  the  familiarity  feedback  contributed  show  perceptions  The  of  the  their  clinicians  on  informal  an  the  be  supervisory  study  issues  need.  also  departments  of competence of  on  their  i n d e p a r t m e n t s of the  professional  level  of  may  f o r which  employed  access  of  different  perceptions  staff  were  small  have  the  r e s u l t s of  for evaluation  certainly  perceptions  of  The  better  identification  would  size  The  have  l e a r n i n g needs e s t i m a t e  respondents  or  may  therapists.  responsible.  allow  the  the  then  thus d i f f e r e n t  supervisory  similarity  accounted  78%  nursing  b a c k g r o u n d s and  t h a n would The  in  and  basis  similarity  assessment  using  of  competency  statements. No  specific  learning reported rank  needs  between  in Chapter  practical,  supervisors The  patterns  have p r e v e n t e d  possible  method a r e  The  emphasis  of  dependent on  that  them as  clinical  tool  on  as  this  the  top  cognitive  and  these  in this  their  competencies. skills  would  study.  were  reported  by  ranked  learning  need.  treatment  approach  f i n d i n g i s that  upon a c c u r a t e  Studies  than  clinical  from o c c u r i n g  of  t h e r a p i s t s would  higher  ranking  competencies  supervisors  identification  s u b s a m p l e s were r e v e a l e d .  assessment  related  in  competencies  such a t r e n d  explanation  and  to"  perceive  this  Evaluation and  the  trends  suggested  "how  would  e m p h a s i s of  clinicians  Two  or  evaluation  of  perceptual-motor  the  both A  client.  evaluation  11 3  reflects  the  physical other  and  tendency  approach  to  the  evaluations. formalized the  or  These new  or  the  the  to  stress  expense  new  treatment  neurophysiological  knowledge of models are  assessment  some  type  of  of  treatment  i n d i v i d u a l , f o r example,  expanding  receiving  at  addition,  dysfunction,  norm-referenced  therapist  In  brain-damaged  updating  training  evaluation  procedures.  to n e u r o l o g i c a l  necessitate  undergraduate  f u n c t i o n a l t y p e s of  assessment  approaches  for  these  often  would  types  of  accompanied  t o o l s which  by  necessitate  t r a i n i n g p r i o r to  their  use. A comparison competency areas  of  the  availabilty  a r e a s and  the  learning  were  sufficient  reported training  perceptual-motor which  ranked  having  i n the  both  top  and five  t r a i n i n g i n e a c h of  needs  opportunities  skills  of  reveals  high  that  sensory  function  learning  a number  learning  available.  needs  although  taking  a  high  a d v a n t a g e of  reasons.  Barriers  learning  need,  appropriate. content. too have  few  and  Evaluation  of  are  two  and  focus  instance,  enrollment  the  change s o . q u i c k l y  of  t h e y may  explanation  a v a i l a b l e to repeat  despite  may  have  for  be  the  i s that  the  also  use  the of  highly  indicates  a  number  greater  program  than  may  not of  their  not  be  insufficent theoretical the  present  programs  neurologically oriented  and  availability that  programs  participation  the  examples  need e x i s t s , t h e r a p i s t s a r e  plentiful  i n number. Many of  limited  readily that  Another  the to  or  For  learning  of  needs  among c o m p e t e n c i e s where p r o g r a m s were a v a i l a b l e . T h i s that  the  resource  programs  p e o p l e who  are  programs. Another p o s s i b i l i t y programs,  the  a need a l w a y s e x i s t s .  are  competency  not is  areas  1 14  Barr i e r s  to Part i c i p a t ion  The family  results  of t h i s  responsibility,  t i m e a s t h e major literature barriers in held  by  having be to  lack  to adult  that  situational  l e a r n i n g . I t was  supervisors  projected  and  onto t h e i r  degree  existed  of  between  appropriate perceiving  committment t h e two  based  I t was  supports  by  as  a  the  that d i f f e r e n c e s  education  w h i c h would  that  would  and  as g r e a t e r  lack  of  clinicians  deterrents  were not  a  Differences  perceiving  barrier  T h e s e d i f f e r e n c e s , however  an a t t e m p t  accompany  therapists.  major  be  supervisors  suggested  the  would  the  barriers  j o b r e s p o n s i b i l t y and c o s t  participation.  on  groups, s u p e r v i s o r s  programs  This  b a r r i e r s are the g r e a t e s t  to continuing  staff.  consider  p r o g r a m s , and l a c k of  hypothesized  clinicians  committment  therapists  b a r r i e r s to p a r t i c i p a t i o n  r e d u c e some- of t h e s i t u a t i o n a l  high  that  of a p p r o p r i a t e  of c l i n i c i a n s '  a greater  suggest  b a r r i e r s to p a r t i c i p a t i o n .  suggesting  perception  study  to  statistically  significant. The  similarity  be a r e s u l t of  of t h e s m a l l  occupational  ratio  creates  awareness  therapy  the  by t h e s u p e r v i s o r s  situational  higher and  two  A  small  groups  the  interaction  i n the s u p e r v i s o r ' s  that  their  supervisory  to attending  staff  clinical  t o have  may  majority  staff-supervisor and p o t e n t i a l  demands made on t h e  therapist. A closer relationship  proposition  their  these  a s s o c i a t e d with  of t h e p e r s o n a l  b a r r i e r s that  committment  expect  size  departments.  would be r e f l e c t e d  The  staff  between  t h e p o t e n t i a l f o r more  time of the c l i n i c a l staff  of p e r c e p t i o n s  ability staff  to  with  the  perceive  identified.  t h e r a p i s t s would have a  continuing  education  programs  t h e same amount of commitment  was  115  not  supported  by  statistically perception ranking the  view  of  would  be  with  suggested  family  created  by  of  supervisor's  programs  w h i c h would c l e a r l y This  a w a r e n e s s of  the  health  care  field  occupational of  this  is  appropriate an  masking  Delivery  that  logical.  clinical  the  excuse  their  of  the  lack  of  staff,  one  with  more  supervisors'  professions  in comparison, Another  in  the  who  report  not  l e s s p r o f e s s i o n a l reasons,  be  attending s u c h as  the  identification  i n t e r p r e t a t i o n of  b a r r i e r , may for  The  programs a v a i l a b l e t o  therapists  a major  these  financial  that  person  other  of  employment.  of  a result  of  point  the  reported  the  as  a  this  lack  attempting programs  of to  while  disinterest.  Systems  a method of  current  be  limited  of  concern  of  . R e a l i z i n g that  acceptable  Delivery  present  be  opportunities  programs as  other  may  cost  balancing  including  to  and  these b a r r i e r s  j o b demands and  major  in  therapists  from t h e  years  not  identification  experience;  more r e l e v a n t  t h e r a p i s t are  Clinical  understood  sample  a  Although  differences  i n d i c a t e the  few  response  b a r r i e r would  finding  offer  be  study.  life,  this was  towards  limited  first in  study.  responsibilty,  be  private  the  experience.  can  with  of  group  appropriate  job  l e a r n i n g new  demands  this  this  barriers clearly  therapist  insecurity  of trend  by  b a r r i e r s . This  a  the  a  responsibility,  three  situational  results  significant,  is  top  the  s y s t e m s were c o n s i d e r e d  evaluating  time,  the  tendency  the  system which  workshop. The to  use  in this  the  is  r e s u l t s of one  or  study p r i m a r i l y  predominant the  two  study  day  at  support  workshop as  as the the the  1 16  vehicle  for  continuing  occupational held that  by  therapy.  clinicians  b e c a u s e of  familiar their  with  staff.  thought  education  The  and  hypothesized  their  experience,  workshops and  have  in  the  differences  s u p e r v i s o r s was  Clinical  to  programs  based  on  therapists,  on  r e c e i v e d more e x p o s u r e  in perception  would  this  the  of  the p r o p o s i t i o n  supervisors  would p r o j e c t  field  be  more  preference  other  onto  hand,  to a l t e r n a t i v e  were  delivery  systems. The  results  according found  the  was  graduated systems  clinical  would  Familiarity the  respondents  more  report  with  the  even  systems  biased  therapists  experience.  in  field  of  than  exposure  the to  used  and  1979).  It  is  with  the  in  groups.  found  in  alternative short course  results  possible lecture  that  and  course this  this  lack  with and  delivery  lab  would study.  systems  was  study.  Typically  which  they  agreement w i t h The  delivery  the  in  No  recently  universitiies  rehabilitation  other  two  alternate  short  in total  differences  preferences;  workshops  of  differences  t h a t the most  i t e m or a l t e r n a t i v e  (Payton,  toward an  the  true.  operation  i f not  i n the  Other  series,  for  c h o o s e an  with,  as  be  workshop  principle will  of  aware  them  support  were s i g n i f i c a n t  recent expereince  preference  other  m i n i ma1.  nor  not  contention  o p p o s i t e may  unknown a l t e r n a t i v e  evening  did  teaching traditionaly  the  familiar  the are  therapists'  methods of  likely  study  of e x p e r i e n c e  to  therapists  that the  support  years  given  and  suggest  the  to p r o f e s s i o n a l - r o l e  between  support  of  of  are  i t , over examples  an of  w o u l d ' l i k e l y have which  they  had  the very o c c a s i o n a l systems  has  been  1 17  The also  similarity  reflect  largely group  the  of  methods used  carried  out  report  are  a preference  for  other  d e l i v e r y systems.  that  they In  current  had  of  the  are  characteristics  fixed  i n t i m e and  of  the  clinical  preferred  distance  instance,  and the  types  avoid  may  It  is  small  education  predisposed programs  to  using  to p a r t i c i p a t e i n  these  offered,  this  and  of  opportunities  results  attending barriers  i n d i c a t e that  that  Another items  sufficently  on  the  are  or  that  they  r e d u c e at  scheduling  identified  short  be  courses  least  the  them more For  television were  some of audio  the  tapes  o b l i g a t i o n to  gaining  which  have  programs  to p a r t i c i p a t e in continuing t h e r a p i s t s must  these.  would  and  and  must  barriers.  home. I f  Correspondence  with  and  education. benefits  outweigh  by the  produced.  explanation the  barriers  situational  a v a i l a b l e i n the  problems.  workshops  therapists  to p a r t i c i p a t e i n e d u c a t i o n a l  home i n o r d e r  systems i s  s y s t e m s w h i c h would a l l o w of  reduce problems a s s o c i a t e d the  direct  around a t t e n d i n g  situational  d e l i v e r y system might  distance  the that  would e x p e c t  some  capacity  radio i s t y p i c a l l y  and  responsibilities  t h e r a p i s t s , one  flexibility  the  Columbia  place  p r e d o m i n a n c e of  The  opportunity  of most of  Because  leave  groups  minimal.  they  family  be  education  British  family  and  two  continuing  T h e r a p i s t s may  a r r a n g e work and  by  these  methods, l e c t u r e and  continuing  same methods u n l e s s  One  the  after.  these  have been  direct  which  patterned  between  in undergraduate t r a i n i n g .  using  interaction,  programs  responses  f o r the  consistency  questionnaire their  meanings  may  not  of have  understood.  results been For  i s that defined  instance,  118  travelling  consultants  supervisors as  who  compared  low  may  Ambiguity  ranking  interpreted  to  T h e r a p i s t s may  identified  ranked  of meaning  of  evening  mean  every  have s e l e c t e d  may  is interesting  t o note that  one c o n d u c t e d satellite  overwhelming p r e f e r e n c e in  this  Geographic characteristic continuing  the  location considered  education.  and  they  was  not  were  clear.  f o r workshops  this  new  s t u d y and t h e  innovations  audiovisual even  in outlying  skills  difficult  differences  One  of  the  aids,  more  in the  pronounced  current  the m a j o r i t y  n e e d s were  to  financial  or vocal  second  planning  in  programming  in  Victoria.  Although  about t h e i r  constraints  t h e n e e d s of t h o s e who  need t o  have made i t  are  geographically  s t u d y was  to determine i f  to l o c a t i o n  of t h e r u r a l  of  the  of programs a r e o f f e r e d i n  areas are often  in relation  was  program  state  a r e a s , Vancouver  of t h e p u r p o s e s of t h i s  exist  Educat ion  therapist  in relation  and knowledge,  to address  isolated.  and Cont i n u i n q  The  Columbia i s that  therapists  special  of w h i c h  the p r e f e r e n c e  f o r workshops was  Locat ion  large metropolitan  update  weeks.  study.  Geographic  British  may  one whose d e f i n i t i o n  systems  clinical  a week f o r s e v e r a l  i n 1975. D e s p i t e  educational  by  been  i n t h e s e v e n y e a r s between  by McGregor  of s y s t e m  have  an a l t e r n a t i v e  It  by  have been a f a c t o r i n  which  evening  over  changed  also  choice  type  preferred  series,  of t h e meaning  not  of t h a t  f i f t h most  certain  has  as t h e s e c o n d  have more knowledge  to i t being  therapists. the  were  and,  i f so,  and u r b a n s u b g r o u p s .  what  the  119  In  order  colleagues was  to determine  i f differences  i n f l u e n c e d the  suggested  i n the  needs and  review  of  the  literature,  c o n t a c t s was  solicited  there  significant  differences  clinical  therapists  differences were  not  in  to the  Learning Two  but,  due  of  differences  i n need  existed.  The  continuing  in  therapists  urban and contacts,  show  are  of  rural major  systems  significant  between t h e two little  The  needs were examined first  estimate  second  education  dealt  of  for  between  evaluation the  as  rural  the  non-motor  reported  the  and  traditional  treatment  these  groups  practical  and  urban  the  area  related  competency  areas,  areas.  innovations  in  the  field  of  of  need  for  the  data  learning  need,  Urban  and  and  f o r the  rural five  perceptual  need e s t i m a t e s  muscle  c o n s e r v a t i o n f o r example. T h i s l i k l e y  area  therapists.  of h i g h e s t  higher  whether  in o v e r a l l  analysis  sensory  to  competency  same competency a r e a  have  in r e l a t i o n  addressed  individual  with d i f f e r e n c e s  needs. C o u n s e l l i n g s k i l l s ,  evaluation  energy  nature,  p a t t e r n t h a t emerges from  emphasizes  more  did  to p a r t i c i p a t i o n  learning  location.  ranked  Although  Needs  geographic  notably  of  preferred delivery  results  to t h e i r  frequency  respondents.  between t h e  and  as  planner.  aspects  The  from  with  therapists  the  to professional  needs  The  in barriers  therapists,  value  learning  identified.  differences of  in relation  contacts  p r e f e r e n c e s of  professional were  in d a i l y  motor  than  the  strengthening  or  reflects  rehabilitation,  top  the  latest  t o p i c s which  were  120  possibly  not  The  included  r e s u l t s of  revealed  only  learning  needs  contention  tendency  rural  all  in  a  'general as  many  comparative  therefore,  the  b e c a u s e of  i n the  in  . light  of  of  vocational  bias  as  the  on  the  therapists  are  therapists  more  health of  care.  therapist, would  This  facilities  would  be  have  in  which  involved  likely  of  the  intent  may  urban  learning  assessment  t o o l was  employed  a  narrower  to  have t h e  In  of  could and  and  c o n d u c t i n g commercial  job  simulation  be  have t a k e n  vocational  i n a more s p e c i a l i z e d aspect  of  learning  t o o l used.  The  were  of  a  survey apply  to  to  competency the  may  describing  educational  be  attempting  the  therapists  needs may  based  history  may  a  have have  interpreted  them  the  evaluation  practise  i n the  exploration  so,  to  example,  both  do  competency  have  s p e c i a l i z e d p r a c t i c e . For  vocational  second  of  therapist  possible.  therapists  skills  based  urban  lack  facility  interpretation  their  was  The  rehabilitation staff,  urban  of  practice.  by  b r o a d meaning w h i l e  The  field  one  i n i d e n t i f i c a t i o n of  therapists  a  in  need  therapists.  rural  while  s t a t e m e n t s upon w h i c h t h e  occurred. Rural  taking  that  of  identification  exist  practise  p r a c t i s e . The  explained  the urban  would  more s p e c i a l i z e d  nature  looseness  a  and,  similarity  competency  the  s p e c i f i c areas  and  assumption  r e s u l t of  to p r o f e s s i o n a l  partially  rural  differences  a r e a s of  The  in  a s i t u a t i o n where t h e  larger,  focus  differences  between  areas  would c r e a t e in  the  specialists  is a  training.  of  in professional  become  the  analysis  acknowledged  generalists often  the  minor  that  commonly  in undergraduate  broad  of  sense  assessment  or  sense. needs  investigated  was  the  121  difference  in  respondents. totaling The  overall A  a l l of  contacts  the  by  significant  rural  programs. T h i s the  therapists  funding  in types  fact  that  numbers  and  urban  in  this  of  study  opportunity  has  allowed  than  urban  and  was  that to  there  were  studied.  because  need  result  workers  urban  contacts was  no  estimates. i s the  financial  non-metropolitan  continuing  h e a l t h care  they  significant  there  in  method t h a t has  rural  their  professional  overall  by  education,  than  of  the  professional  need  to attend  may  to  competencies  for this  rural  by  calculated  therapists,  the  to l a r g e r c e n t e r s  isolation  was  of c o n t i n u i n g  the  i s one  30  overall  explanation  funding  need  relation  a v a i l a b l e for health care  to t r a v e l  increased  of  expressed  hypothesis  d i f f e r e n c e between  possible  decrease  the  between  experienced  assistance  this  greater  Despite  differences  areas  -a  need  f o r the  disadvantaged  exhibit  One  estimates  more f o r m a l i z e d  colleagues.  of  estimate  behind  are  and  would  need  single  assumption  therapists  degree  been  education  introduced  workers.  The  rural  have been b e n e f i t t i n g from  attend  t h u s not  programs  perceived  therapists  who  that  the  themselves  have  ready  to  the  special  in  greater  access  to  opportunit i e s . Another  possible explanation  therapists  make  b e c a u s e of  their  for  a  greater  location.  for this  effort  Aware of  t o meet t h e i r their  p r o f e s s i o n a l e x c h a n g e , t h e r a p i s t s may  financial  resources  professional possiblity  skills  that  rural  to ensure and  that  knowledge.  t h e r a p i s t s are  result  they  limited spend are  Related  up  i s that  rural  l e a r n i n g needs opportunities  greater  time  to date  in  to  this  is  and  their the  a c t i v e i n a l t e r n a t i v e forms  122  of  continuing  Independent  education  study  programs  exchange p r o g r a m s , and workers are outlying relation cannot  be  to a  this  Because the  competencies, practise  rural  learning  the  calculated  than not  urban  of  the  of  the  of  therapists  reported  the  c o m p e t e n c i e s more r e l e v a n t  did  urban  therapists,  significantly unpredicted assessment the  similarity tool  Barriers The  of  this  to  in  specialist.  The  between  the  that  the to  have two  need  relevant lower  of  rural  their  score of  two  supported  the  were  to  to  bias  have that  than  found  contributed  estimate  the  the  practise not  may  to  therapists  g r o u p s . The  rural therapist  overall  as  of  be the the  minimized expected  study.  Participation  results  differences  may  considered the  in a  t h i s d i f f e r e c e was  This  toward the  differences  results  but,  different.  urban  the  parallel  statements  groups  and  for  need. A c o m p a r i s o n  competency  in  statements  typically  resulting of  in  learning.  explanation  are  met  education  have been c o n s i d e r e d  indicated  be  care  considered  would more l i k e l y  estimate  health  competency  another  therapists  i n t o the  mean r e l e v a n c e  continued  that  journal  needs c o u l d  continuing  the  is  surveyed  t h e n , may of  of  study.  loan,  t h i s s t u d y must be  therapists'  practise  this  exchanges with other  of  study  areas  therapists  total  nature  in  interlibrary  t o a l l methods of  in  generalists,  being  informal  r e s u l t s of  general  investigated  the  using  limited definition  applied  The  rural  investigated  methods t h r o u g h w h i c h  a r e a s . The  results.  not  of  between  this urban  study and  rural therapists  hypothesized in r e l a t i o n  to  123  barriers Rural  to  therapists  barrier, in  participation  an  usually with  only  easy  rural group.  The  program  as  reasons  supports a case to  Although  still  for  identifying  those  reported  lack  of  by  time, are  barriers  urban  difficult  p l a n n e r s may  providing  more s p e c i a l i z e d  an  attempt  bringing  the  the  conscious  of  an  reduce  to  i n d i r e c t way  the  barriers of  facilitate  Delivery One  services  to  of  family  to  the  in  by  for  systems  facilitate  the this  discussed reduce  the  therapists.  participation,  responsibilty  planner by  related  to  address.  changing  relocating  the  In  and some  schedule,  the  program  increased  p a r t i c i p a t i o n . Perhaps  attention  of  the  respondents  that  addressing  awareness through c o m p l e t i n g and  the  are  therapists  reported  planner  preferences  barriers  questionnaire, the  the  should  areas  participating  delivery  for  major  situation  barriers  special  p r o g r a m s , or  encourage  barriers  completing  is  to  for  the  Urban  barriers  therapists,  instances  in  the  as  current  not  The  preferred  consider  the  programs.  in metropolitan  for  programs.  response  and  transporation  reported  below, however, makes i t d i f f i c u l t barriers  education  available.  programs  education  therapists  of  where workshops  to  situations  continuing  lack  t y p e of  access  continuing  response c o n s i d e r i n g  Columbia  the  personal  ranked  expected  British  in  pertain the  will  to  them  issue,  at  may  through  least  . Although  r a i s i n g the  a questionnaire  p a r t i c i p a t i o n to  therapists  by  be this  level  of  reduce  barriers  study  was  some d e g r e e .  Systems of  preference  the  most u n e x p e c t e d  of  both  urban  and  results rural  of  this  therapists  f o r one  of  the the  124  direct  d e l i v e r y systems,  rural  therapists  greatest  the  one  identified  or  two  day  transportation  b a r r i e r s to p a r t i c i p a t i o n , they  s y s t e m s w h i c h have the results  indicate  courses arranged  workshop.  p o t e n t i a l to  and  distance  d i d not  prefer  reduce these  that  respondents  in their  locality,  want  Although the  delivery  barriers.  workshops  which are  as  often  or  The short  financially  prohibit ive. Similar preference  t o the  of  d e l i v e r y system  familiarity  with  systems  the  is  differences literature for  expected on  Rural the  therapists  than  have l i t t l e the  the  rural  that  they  social  that  these  for continuing  the  the  health  care  workers  education,  one  systems  be  or  no  in  by ' r u r a l  practical  this  would  options.  experience  study  may  have  have p a r t i c i p a t e d i n  previously  i n t e r e s t e d i n but  which  distance  education  of  on  the  they  part  s y s t e m s would a c t u a l l y  purposes  is  also  of be  reflected  results.  These to  t h e r a p i s t s . Although  distance  included  t h e y may  distance of  by  for  knowledge. P e r h a p s some s k e p t i c i s m  therapists  instituted in  those  to the  lack  continuing  little  the  supervisors,  w h i c h o f f e r e d a number of  a l t e r n a t i v e s which they  rather  urban  for  having  systems  and  explanation  a l l t y p e s of  a questionnaire  r e s u l t s of  s y s t e m s compared  preference  support  f o r the  clinicians  and  a general  more  distance  reported  by  logical rural  in  proposed  direct  most  reflects  therapists  with  the  between  workshops  have  explanation  results  suggest  that  t h e r a p i s t s o u t w e i g h the necessitate.  interchange  The  i s one  the  financial  opportunity of  the  benefits and  of  direct  time  systems  committment  f o r both p r o f e s s i o n a l  well-documented b e n e f i t s  of  and the  125  direct  delivery  suggesting  that  opportunities s t u d y , and attempt  systems the  rural  for  advantage  the  decrease of  the  to  travel  therapists  may  have  different  area  One  the  present  for  the  available. differed specified. the  due  to  to  in t h i s  This had  the  while  response  interest  indicating  5)  was  this  than  3%  compared  fact  that  system  system  area  will  i t was  low  addressed  to  a  usual  and  24%.  of  system  in  This  may  correspondence specified.  this  s t u d y may  accumulation i n the  The  reflect  academic c r e d i t  of  that  number  delivery  not  credit  were have been  implications  of  study.  Assessment  A the  their  study  stipulated  results  or be  travel  i n M c G r e g o r ' s s t u d y may  the  certification  in  to  i f some t y p e of  that  to  Rural  sytems.  a preferred  study  center.  relatively  she  an  provide  usually  between t h i s the  be  they  change  direct  this  Another  as  in t h i s  suggests  This  for  in  isolation.  a desire  a  data fewer  s y s t e m s may  metropolitan  preference  less  direct  larger  experience  (Note  supported  i s that  correspondence  credit,  healthy  to  for  1980). The  significantly  systems  major d i f f e r e n c e s  study, be  a  has  professional  been  McGregor  to  partially was  the  by  responses  or  to  in t h e i r  of  conducted  this  Smith,  c o n t a c t s was  preference  direct  opportunity  environments  therapist  professional  therefore  to  (Langerman and  secondary assessment  p u r p o s e of of  this  Tool  study  continuing  was  to  education  test  a  needs.  tool With  for a  126  comprehensive the  assessment, planners  programs  they  participants. tool  as  Supporting  i s the fact  study  offer  that  major  general  barrier  lack  planners  reflect  t h e need  o f programs  a r e not basing  for  employed  to  provide  some  to  decisions  areas  limitations  of  statements  rather  suggested  as  by of  This  could  this  programs indicate a  therapists  on a c c u r a t e  or  that  information  relevance.  for  programming.  Although  interests,  learning  in the  this  needs a r e o f t e n  study  attempted  traditional  according  than  speciality  programming  areas  overcome  tool.  a r e a s or d i s e a s e i n an a t t e m p t  desired  n o t a s s e s s e d . The to  assessment  these  the  Competency  entities  were  t o have t h e t o o l  t o a s many t h e r a p i s t s a s p o s s i b l e . The need was q u a n t i f i e d  having  the respondent  competetence  values.  in  As a f u r t h e r  competency solicited are  in  o f need a s a gap between e x i s t i n g and  knowledge and s k i l l s , used  findings  of a p p r o p r i a t e  i n d i c a t i o n of the t h e r a p i s t s '  instrument  assessment  a c h e c k l i s t t y p e o f i n t e r e s t s u r v e y h a s been  identify  the d e f i n i t i o n  apply  unexpected  occupational  their  that  needs o f t h e p o t e n t i a l  participation.  t h u s o f f e r i n g programs of l i t t l e Traditionally,  the  i n d i c a t i n g a lack to  be more c o n f i d e n t  f o r a comprehensive  one of t h e  was t h e r e s p o n s e  a  could  area i n order  not p r e s s i n g  to  s t a t e both d e s i r e d  the  areas  guide the  suggested  f o r planners, practise  and e x i s t i n g  and s u b t r a c t i n g t h e  the relevence  of o c c u p a t i o n a l  to current  of  was  exist  but  p r a c t i s e and t h o s e  that tool  require  immediate a t t e n t i o n . T h i s  format  f o r the assessment  allowed  needs t o  which  facilitated  be  quantified  among g r o u p s and r a n k i n g  each  therapy  t o d i s t i n g u i s h between needs t h a t in relation  levels  o f needs a s t o i m p o r t a n c e .  comparison  1 27  In  reviewing  distribution o r no  list  on  of  with  t h e most  3,  indicating  an  area  that  of o c c u p a t i o n a l t h e r a p y .  of p r i o r i t y  relation  to  planning An  results  and  competence  practise  needs  overall  i n the  f o r the  l e a r n i n g n e e d s , an was  availability  of  the  relevance  of  to  the  included similar  in this tool  physical  by  of t h e  tool  medicine  is  instrument  the  should not  be  be  considered.  translated  one  participation  or  k n o w l e d g e . Because t h i s  of an  the  of  the  i t may  be  compared,  Analyzing  areas  in in  to p r a c t i s e itself.  to therapy,  and  responses  to  support  competencies  in  nature;  a  p s y c h i a t r y or more  detailed  planner. tool,  participation  than  instrument  a better  list  need  gave  have p r o v i d e d  of  are  The  approach  is  programs  the  general  f o r the  it  learning  relatively  stronger  traditional  the  priority  of whether p r e s e n t  component p a r t s o f need, and  interest,  many  be  to  useful  in  the  i s s u e of  resultant  In many i n s t a n c e s i n d i c a t i n g  to  and  d e c i s i o n s and  In a d d i t i o n t o t h e  into actual participation may  is  suggests  comparing  were  predict  relevant  which  tool  f o r example, may  can  0,  between e x i s t i n g  planning  In e v a l u a t i n g a needs a s s e s s m e n t the  bimodal being  When t h e means were  responses.  information  responses  highly  questionnaire  f o c u s s i n g on  program c o n t e n t  of  the competency  relevance  a gap  a  future.  indication  training  assessment  frequent  term  planner.  provided  the  revealed,  short  evaluation  use  effective  was  supporting  f o r programs  practical of  found  need e x i s t i n g  desired  a  was  the  took  into  a need  skills a  number  more  of p a r t i c i p a t i o n planner  may  barriers  in  account  t h e r e f o r e tapped  The  programs  the  the d i s c r e p a n c y  indicator  instruments.  because  whether  than than  however, must  128  be  cautioned  a g a i n s t assuming  into attendance  the  programs.  Limitations  Design  In  was  supervisors  in  made  in  general  a  attempt  perceptions  of  continuing  in  relation  factors  A  very  was  made  match  to  to  a  thus  the  supervisory in  that  large the  of  supervisors!  their  own  hold  the  group  would match t h e  and  used  technique,  manner to  translate  design  and  compared  work s e t t i n g  staff  two  a  groups  number  of  constant. in  the  wording  some c o n f u s i o n  f o r the  results.  Notably  case  indicate  their  in the  perceptions  t h a t the  preferences  wording  may  investigating systems  broad  education  produced  and  sampling  more r i g o r o u s d e s i g n  to t h e i r  Problems  possible  the  research  therapists  were  No  i n the  to  clinical  clinicians.  perceptions.  exist  relation  between  therapists  of R e s e a r c h  limitations  study.  comparison  directly  at c o n t i n u i n g education  A number of in  t h a t needs w i l l  in  variables.  points  also barriers only  T h e r e was  understanding  have  by  no  the q u e s t i o n n n a i r e  respondents  where t h e of  have  the  an  effect  to p a r t i c i p a t i o n one  item  was  opportunity  comparing  staff's indicated  throughout had  thereby  may  have  biasing  the  s u p e r v i s o r s were a s k e d  their  s u p e r v i s o r s may  at  that  of  and  their  it  own  on  the  delivery  u s e d t o t a p e a c h of  that  The  questions  preferred  the  is  needs  questionnaire.  to v a l i d a t e  questions  needs,  to  these  respondent's  tapped  similar  informat i o n . Although  comments r e g a r d i n g  the  questionnnaire  were welcome  1 29  as  indicated  subject  of  a  regarding was  not  covering of  focussed  on whether  would have  by  only  according training  this  was t h e  The  item  i n t h e competency 12  to  referred  or t o other reduced  one a r e a  respondents.  of t r a i n i n g  defined  of r e h a b i l i t a t i o n  wording  letter,  comments  availability  sufficently  field  precise  the  number  the  Questions the  in  area  respondents. s p e c i f i c a l l y to  h e a l t h care  areas.  More  problem.  Implicat ions  Continuing practise often and with  preferences relevant  improvement  ability  the  of  a  planning  professional  competent  program  to assess  participants  and  is  t h e needs  to  respond  of m o t i v a t i o n t o  learning  is  of the l e a r n i n g e x p e r i e n c e s one o f t h e p u r p o s e s  of  directly they  this  have study  i n f o r m a t i o n w h i c h would c o n t r i b u t e t o t h e  of c o n t i n u i n g e d u c a t i o n  British  Columbia.  The  and some s u g g e s t e d  opportunities for therapists  implications  of t h i s  guidelines will  study  f o r the  be p r e s e n t e d  in  the  section. One  use  The s u c c e s s  to  p r o g r a m s . The t h e r a p i s t ' s l e v e l  i n .Therefore,  was t o g a t h e r  next  of the p o t e n t i a l  by t h e q u a l i t y  participated  fundamental  upon t h e p l a n n e r ' s  t o be i n v o l v e d i n  influenced  planner  is  of o c c u p a t i o n a l t h e r a p y .  dependent  continue  in  education  of  of t h e major supervisory  information. perception  Based  i m p l i c a t i o n s of t h i s therapists  on  the  as  results  about c o n t i n u i n g e d u c a t i o n  supervisors,  it  can  be  concluded  a  study  source suggesting held  that  by  relates of  t o the  planning  s i m i l a r i t y of clinicians  and  supervisors are f a i r l y  1  accurate  in predicting  In B r i t i s h  Columbia,  accessible meeting basis the  to  held  the  by  with  the  planner.  planner  may  financial  demands  of  information.  large  departments  in  their  ability  perceive  could  both  as  a  preferences  unwise  to exclude  continuing The  of  patterns  clinicians.  a  location stay  of  the  the  flexibility  rarely  a better  clinicians  tied  of  Both  information  for  in  the  staff's  needs  on  supervisor  the  the  and  clinicians  the  be  on  able  clinicians, from  of  case  in  because  of  does not  exclude  planner  should  progarm  to p r e d i c t  having  of  more l i m i t e d  i t would be  supervisors  direct  as  than c l i n i c i a n s  The  planning the  needs  politicaly input  on  the  current  a primary i s based  into  gauge of in that  for a greater the  of  and  work s e t t i n g .  s u p e r v i s o r s ' working hours  to p a t i e n t appointments  schedules,  has  geographic  of  l e a r n i n g needs and  particular  the  jobs  supervisors period  of  employment  availability jobs  source  b o t h on  transitory  (Maxwell,1977). Because  same work s e t t i n g  likely  used  where t h e r a p i s t s change  frequently  are  individual  numbers.  their  s u p e r v i s o r s and  situation  i n the  be  information;  rather  accessibility  created  monthly  i f s u p e r v i s o r s were a major  of  their  use  information  of  small  very  programs.  suggested  planning  their  the  an  be  clinicians  education  on  s u p e r v i s o r s may  s u p e r v i s o r s may  of  them  staff.  are  attend  gathering  should  that  supervisors  of  reduced  Caution  source  committee. Although and  be  numbers. F o c u s s i n g  clinician  approach  e a s e b e c a u s e of  source  consider  The  or  programs  the  their  supervisors  planning  increased  of  therapy  supervisors  to  preferences  occupational  relative  t i m e and  needs and  30  tend  time,  to  they  preferences In a d d i t i o n ,  in that would be  they an  are asset  131  to  the  planner.  Implications therapists  are  innovation. urban and  for  programming  clear  but  Although  rural  therapists,  different  consider  for  therapists  larger  group  resources.  Had  been h i g h e r  not  this  rural  the  urban,  g r o u p as  participate  type  not  time  financial  less  support  of  that  preferred  report  practically rural  planner  must  group c o n s i d e r i n g  the  the  of  limited the  financial  rural  therapists  would have been p r o v i d e d The  in  fact  that  a  systems t h a t  attempting  for  preference may  have  met  the  that  t h e r a p i s t s would a t t e n d the  the  would  opportunity  to  project  the  while  they  only  planner  to a p i l o t  in  address  systems,  were  f o r the  system  to  is possible  distance  systems  resources  delivery  not  b a r r i e r s to p a r t i c i p a t i o n i l l u s t r a t e s  necessary  rural  between  few  and  delivery  prefer  distance  I t would be  proposition  therapists  encountered  available. and  to t h i s  i s o l a t e d therapist. It  if  than  so  questionnaire,  a priority.  reduced  t h e r a p i s t s do  rather  to  Because  o v e r a l l need e s t i m a t e  difficulties  rural  did  preferences  priority  urban  needs and  geographically  therapists  or  the  low  shown f o r the  learning the  a  the  restraint  programming.  to  of  than  addressing was  give  rural  needs  special  responded  realistically  suggest  for  m i n i m a l d i f f e r e n c e s were r e p o r t e d  sufficiently them  specifically  commit  the  t o examine  the  a program u s i n g  absence  a  of  other  the  planner  alternat ives.  is  The  information  derived  from the  results  suggest  perceptual-motor  of most  immediate  needs a s s e s s m e n t  that skills  evaluation are  the  relevance  section of  areas  of  the  cognitive that  are  to  study.  The  function  and  relevant  to  the  132  practise  of  occupational  therapy  g r e a t e s t . The a r e a of v o c a t i o n a l also of  emphasized  training A  and  of competency  high a v a i l a b i l i t y  number  of  sufficent  not  in  in this areas  exist  be  of  number,  in  the  or perhaps  present  quality,  One  the  to  require may  updating,  need  planners  areas  is  they  As many o f  have l i m i t e d  the  enrollment,  estimates that  may  not  the l e a r n i n g  is  that  necessary.  be  need.  assessment of Materials  meet t h e l e a r n i n g  existing  a  to participation  methods o f p r e s e n t a t i o n m o d i f i c a t i o n ,  t o be r e f o c u s s e d t o b e t t e r  the p a r t i c i p a n t s . areas  i n these  was  planning process.  the b a r r i e r s  a r e g r e a t e r than  programs  h i g h need  values. This suggests  adequate  implications  treatment  because of the l a c k  had b o t h  by t h e r e s p o n d e n t s  existing  and  t h e need i s  area.  reported of  which  assessment  of t r a i n i n g  problems  Programs may  in  and s h o u l d be g i v e n p r i o r i t y  programs a v a i l a b l e  number  and  programs  may  or t o p i c needs o f in  these  r e p e a t i n g them more o f t e n may  be  competency  in  necessary. The this  study  utility is  general nature has  been  planners  information  by  behaviorally areas  The reported  may  a  number  tool  such  be  able  focusing  oriented  with d e t a i l e d  greater  noted  o f an a s s e s s m e n t  clear,  of t h e  the  statements  descriptions,  to  collect  competency  in  the study  program p l a n n e r . A s i d e  assisting  in  study  practical Using  to  fewer  information  of  of p r o g r a m s .  barriers  can not e f f e c t i v e l y from  more  assessment  result  i n c i d e n c e of s i t u a t i o n a l  in this  statements.  or l i m i t i n g may  used  of t i m e s . A l t h o u g h the  as t h e one u s e d  a s s i s t a n c e i n the implementation high  statements  to participation  be d e a l t  the  w i t h by t h e  therapist  in  the  133  identification step  of  b a r r i e r s , awareness h o p e f u l l y  in attempting  often  beyond  barrier,  lack  majority  of  One  to  the  reduce  r e s p o n d e n t s and of  i n s u f f i c e n t number of  be  relevant  and  but  avoid  new  too  interest is  experienced  findings  of and  studies r e d u c e the  Another programs  is  participants. accurate provide  number  f o r the  response The  to  groups one  to  way  planners  plan  planner.  all  on  a consultation  s u c h as  this  c h a n c e s of  addition,  the  e x i s t i n g programs are  assessment a true  the  of  Frequently,  the  information  is  of  the  programs assessment  so  time be  needs of to  i t can  gathering  would  of  implications  of  of  also  procedure  acted  the  of  of  appropriate  relevant  that  is  new  to to  tools  cost  is  which are  necessary.  information  and  the  this barrier.  analysis the  the use  t h e r a p i s t s and  reduce and  and  co-operative  relevance  t i m e and  consuming  before the  the  in relation  t i m e between  implementation  the  would  programs.  not  p r o c e d u r e s . Development  reflection  Minimizing  increasing  lack  basis  d i s t r i b u t i o n of  d u p l i c a t i o n of the  Making  programs  would e n c o u r a g e  that  method of  the  may  continuing  numbers.  quality  is  interested  own  increase  In  there  associations  to  pitfalls.  the  e x i s t i n g ones  their  better  are  by  i s that  allow  interpreting  One  first  institutional  reported  implications  of  efficient  One  in  One  was  way  relatively  outdated  has  program p l a n n e r s produce  common p l a n n i n g  efforts  programs,  programs o v e r a l l .  few  programs  available help  planner.  to p a r t i c i p a t e . Encouraging p r o f e s s i o n a l  special  education  the  interpreting this  an  therapists  of  appropriate  method  the  barriers, situational barriers  control  of  being  of  information  the is  upon. this  study  derived  from  the  134  results  of  the  workshop method delivery  of  Considering  preference should  financial  rather  Specifically, television present least  priority  than the  time.  resources  r e t a i n e d as  on  development  of  not  lack  the  results  of  to  be  from  the  of  any  limitations  of  the  from  information  study.  The  major  recommendation  continuing education  similar  to  limitations instrument findings care,  this of  and have  this  and  one  support the  from  and  Study  research  project  design  into  replicated  research  hypothesized  the  of  the at  limited than  the  to  number  of  these  the  arise  original  further  that  research  i s that a  study,  condsideration  to v a l i d a t e  both  t h e methods u s e d and  in related  would use as  a  conducting  relationships  sub-samples  via  at  the  Often  through  in relation  A more r i g o r o u s s t u d y  match  systems.  a priority  for Further  taking  be  relevant  programming  in o c c u p a t i o n a l therapy  design,  in  them.  revealed  but  areas  more p r e s s i n g p r o b l e m  r e s u l t s . A l t h o u g h some of  a number of  investigation. size  study  research  or  the  programs would a p p e a r ,  r e s e a r c h p r o b l e m s become a p p a r e n t .  study  on  of  of  delivery  considered  this  a  the  therapists.  to o f f e r i n g  of new  ways of d e l i v e r i n g  completion  associated  be  general  new  given  educational  The  Recommendat i o n s  Upon  be  i n t r o d u c t i o n of  available,  the v a r i e t y  development  should  i s that  opportunities for  should  the  systems  t h e major v e h i c l e f o r  c o n s t r a i n t s and  satellites  based  delivery  continuing education  w h i c h needs e x i s t , topics  be  of  a  closely  areas  of  the the the  health  deserve  further  larger  sample  as  possible.  135  Particularly  in  the  clinicians,  matched  the  the  value  of  Although assessment  30  of  the  education independent  Those  and  also  examined  location  a  broader fruitful.  study  used  Canadian not with  tested using  study  were  formal  their  not  types  skills  and  of  could  have  on  in  inter-library benefit  particularily  this  journal loan,  from  a consultation basis. Studies  implications  in  learning.  knowledge t h r o u g h  of  of a p l a n n e r  engaged  continued  assisted  learning  continuing  investigated  computer  types  of  Therapists  as  of  or the  this  to planning  for  considered  in  therapists. Another  this  study  facet was  of c o n t i n u i n g programs  becomes m a n d a t o r y as likely  needs  credit  therapy and  for  education credit.  i n a number of  t h a t some t y p e  occupational the  more  the  be  definition  programs such  is  using  dealing  should  self-structured  rural  by  needs  T h e r a p i s t s , which t h e m s e l v e s a r e  prove of  update  would  increase  the  study  identified  reading,  group  in  i s recommended. T h i s  geographic  which emphasized  assistance  and  areas.  types  that  numbers would  further  relationships  utilizing  may  supervisors  statements  competencies  The  competency  project,  statements  138  role  Research  to  larger  competency  of O c c u p a t i o n a l  professional  and  satisfactory,  defined  inclusive.  other  of t h e  appeared  Association all  samples  related  findings.  use  behaviorally only  questions  of  i n the  preferences  p r o g r a m s would be  credit  not  If continuing  other  health care  system w i l l  future. A similar of  the  be  valuable planning  fields, i t  necessary  study  subsamples  education  in  focussing  on  in relation  to  information.  136  One  of t h e p u r p o s e s  learning would to  needs t o i n c r e a s e t h e i r  be  the  of i n t e r e s t barriers  participants strengths  and  of  participation whether  of t h e s t u d y was  the were  respondents  meet a s p e c i f i c  utility  t o attempt  participation  to  develop  assessed. would  learning  a  need.  the  identified  formula  needs This  in fact  to  to quantify planner.  t o a s s i g n some n u m e r i c a l  to  learning  t o attempt  whereby  compared  to  would be one  attend  by  programs  It  value  potential the  relative  barriers  to  indication  of  designed  to  137 REFERENCES A i t k e n , A. Audio methods i n c o n t i n u i n g medical e d u c a t i o n . M e d i c a l B i o l o g i c a l I l l u s t r a t e d , 1964, 14, 259-262. 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Research: the v a l i d a t i o n of c l i n i c a l Philadelphia: F. A. Davis Co., 1979, 57-69,  a  practice.  Pearson, K. D i a l access l i b r a r i e s : t h e i r use and u t i l i t y . J o u r n a l of M e d i c a l E d u c a t i o n , 1979 , 4_9, 882-896 . P e r r y , J . W. Career m o b i l i t y i n a l l i e d h e a l t h e d u c a t i o n . of American M e d i c a l A s s o c i a t i o n , 1969, 210, 197-210.  Journal  P e t e r s o n , R. E., and A s s o c i a t e s . Community needs o f p o s t secondary a l t e r n a t i v e s . Sacramento, C a l i f o r n i a : California L e g i s l a t u r e , 1975. P o l c y n , K. A. An educator's guide t o communication s a t e l l i t e technology. Washington, D.C.: Academy f o r E d u c a t i o n a l Development, 1973, 3-8. P o p i e l , E. A s s e s s i n g and determining t r a i n i n g needs. In E. P o p i e l (ed.) Nursing and the process o f c o n t i n u i n g e d u c a t i o n . S t . Louis:' C. V. Mosby Co., 1977 , 49-59. P r i c e , E. Learning needs o f r e g i s t e r e d nurses. Columbia U n i v e r s i t y , 1967.  Teachers C o l l e g e ,  Punwar, A., £ Werdt, E. C e r t i f i c a t i o n o f o c c u p a t i o n a l t h e r a p i s t s i n the p u b l i c s c h o o l s : the Wisconsin experience. American J o u r n a l o f O c c u p a t i o n a l Therapy, 1980 , 3_4 , 727-730, Ramey, J . W. T e l e v i s i o n i n medical t e a c h i n g and r e s e a r c h . Washington: U. S. Government P r i n t i n g O f f i c e , 1967. Rodowskas, C , E'Evanson, R. Continuing education i n pharmacy, m o t i v a t i o n and content. American J o u r n a l of Pharmaceutical E d u c a t i o n , 1969 , 3_3, 735-741. Ruyle, J . , E Geiselman, L. A. N o n - t r a d i t i o n a l o p p o r t u n i t i e s and programs. In K. P. C r o s s , J , P. V a l l e y and A s s o c i a t e s (eds.) P l a n n i n g n o n - t r a d i t i o n a l programs: an a n a l y s i s o f the i s s u e s f o r post-secondary e d u c a t i o n . San F r a n c i s c o : Jossey-Bass, 1974.  142 Seymour, R., C o n n e l l y , T., £ G a r d n e r , D. Continuing education: an a t t i t u d i n a l s u r v e y o f p h y s i c a l t h e r a p i s t s . Physical T h e r a p y , 1979 , 5_9 , 399-404. S m a l l e g a n , M. Continuing education: how do you b u i l d a program? The J o u r n a l o f C o n t i n u i n g E d u c a t i o n i n N u r s i n g , 1981, 12, 12-15. S m o r y n s k i , H., £ P a n o c h a , J . Providing continuing education o p p o r t u n i t i e s i n the a l l i e d h e l a t h p r o f e s s i o n s . J o u r n a l of A l l i e d H e a l t h , 1979 , _8 , 47-54 . S p i c e r , M. R. Travelling teacher. J o u r n a l of Continuing t i o n i n N u r s i n g , 1975 , 6_, 17-21. S t a u b , F. M. following 8-13.  Educa-  A study of job s a t i s f a c t i o n of nurse p r a c t i t i o n e r s an i n s e r v i c e p r o g r a m . League E x c h a n g e , 1967, 79, ..  S t r o s s , J . K., £ H a r l a n , W. R. The i m p a c t o f m a n d a t o r y c o n t i n u ing medical education. J o u r n a l of American M e d i c a l A s s o c i a t i o n , 1978 , .234 , 2663-2666 . T a y l o r , M., D i c k m a n , W., £ Kane, R. Medical students' attitudes toward r u r a l p r a c t i s e . J o u r n a l of M e d i c a l E d u c a t i o n , 1973, 4J_, 885-895. V a i l l a n t c o u r t , D., £ G i l l , M, C o n t i n u i n g m e d i c a l e d u c a t i o n by television: a Canadian e x p e r i e n c e . Canadian M e d i c a l A s s o c i a t i o n J o u r n a l , 1968 , 9_8 , 1136-1139 . V e r n e r , C. A d u l t e d u c a t i o n t h e o r y and method: a conceptual scheme f o r t h e i d e n t i f i c a t i o n and c l a s s i f i c a t i o n o f p r o c e s s e s f o r a d u l t education, Chicago: Adult Education A s s o c i a t i o n , 1962 . Wagner, R. M. The t e a c h i n g o f a d u l t s i n t h e c o n t e x t o f d i s t a n c e education. I n H. R. B a k e r ( e d . ) The t e a c h i n g o f a d u l t s . Saskatoon, Saskatchewan: U n i v e r s i t y of Saskatchewan, E x t e n s i o n D i v i s i o n , 1977, 1-6. W a l s h , P. A model f o r p l a n n i n g c o n t i n u i n g e d u c a t i o n J o u r n a l o f A l l i e d H e a l t h , 1981, 10, 101-106.  for  impact.  Weaver, C. H. C o n t i n u i n g e d u c a t i o n f o r emerging p r o f e s s i o n s . J o u r n a l o f A l l i e d H e a l t h , 1979 , 8_, 11-15. W e c h s l e r , H., e t a l . C o n t i n u i n g e d u c a t i o n and New England dentists: a questionnaire survey. J o u r n a l of American D e n t a l A s s o c i a t i o n , 1969 , 7_8, 573-576 . W h i t e , D. K. personnel. 1975 .  Continuing Chicago:  e d u c a t i o n i n management f o r h e a l t h c a r e H o s p i t a l R e s e a r c h and E d u c a t i o n a l T r u s t ,  143  W o o d s i d e , H. Basic issues i n occupational therapy education today. C a n a d i a n J o u r n a l o f O c c u p a t i o n a l T h e r a p y , 1977, 4_4, 9-16 .  144 REFERENCE NOTES  Brintnell,  J.  P e r s o n a l communication,  B r o o k f i e l d , S. D. Distance education. f o r p u b l i c a t i o n , 19 82. D i c k s o n , D.  P e r s o n a l communication,  October  3, 1981.  Manuscript submitted  September  24, 1981.  G o b e r t , R. C. M.I.R.C. p r o j e c t . U n p u b l i s h e d M.A. U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1977.  thesis,  M c G r e g o r , L . O c c u p a t i o n a l and p h y s i c a l t h e r a p i s t s i n B r i t i s h Columbia. U n p u b l i s h e d M.A. t h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1975. Q u a s t e l , L . L e a r n i n g needs and j o b s a t i s f a c t i o n o f community mental health workers. U n p u b l i s h e d M.A. t h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1979. S c o t t , A. S u r v e y o f c o n t i n u i n g e d u c a t i o n heeds o f t h e r a p i s t s i n B r i t i s h Columbia" U n p u b l i s h e d m a n u s c r i p t , 1978. ( A v a i l a b l e from School o f R e h a b i l i t a t i o n M e d i c i n e , U n i v e r s i t y o f B r i t i s h Columbia, Vancouver, B.C.). S t a n , L . J . The human r e l a t i o n s s u p e r v i s o r y s k i l l s o f r e h a b i l i t a t i o n m a n a g e r s. U n p u b l i s h e d M.A. t h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1980.  APPENDIX A QUESTIONNAIRE  146  UNIVERSITY OF BRITISH COLUMBIA CONTINUING EDUCATION IN REHABILITATION MEDICINE QUESTIONNAIRE PLEASE RETURN BV DECEMBER 20,  19S1  TO:  Lautia Hcuivty, ViAtcXoK Continuing Education in RthabiZiXation UtditUne. The. UnivesuiXy o£ BniXiih Columbia. *J05 - 2194 Utibwok Uall Vancouvvi, B.C. V6T 1US  SECTION I 1. In which geographic d i s t r i c t do you work? Vancouver & Lower Mainland Victoria Vancouver I s l a n d (other than Greater V i c t o r i a ) Fraser Valley  Thompson/Okanagan Northern I n t e r i o r Central I n t e r i o r  2.  How f r e q u e n t l y do you have o p p o r t u n i t y to d i s c u s s p r o f e s s i o n a l problems and i s s u e s with a t l e a s t one other occupational t h e r a p i s t ? Daily Monthly Weekly Less than 6 t i n e s a n n u a l l y  3.  What i s your present job t i t l e ? Staff Therapist Senior T h e r a p i s t Sole Charge Assistant Supervisor Supervisor  Program C o - o r d i n a t o r / D i r e c t o r Instructor/Professor/Lecturer Consultant Other (please s p e c i f y ) —  A c l i n i c a l t h e r a p i s t 1s a t h e r a p i s t who 1s p r i m a r i l y Involved 1 n d i r e c t p a t i e n t care A s u p e r v i s i n g t h e r a p i s t Is one who delegates the r e s p o n s i b i l i t y o f 'patient care and spenas the m a j o r i t y o f time 1n admin s t r a t i v e o r s u p e r v i s o r y a c t i v i t i e s . In which r o l e do you f u n c t i o n most often? C l i n i c a l Therapist Supervisory T h e r a p i s t 5.  How many occupational t h e r a p i s t s do you have under your d i r e c t i o n ? (Do not Include students.) 1 - 5 6-10 11 - 15 ! » ™ than 16 0  6.  r  How many years experience In occupational therapy have you had? . continued  147  -2SECTION II If you have checked c l i n i c a l therapist i n item #4, specifying role, complete the remander of the questionnaire as i t pertains to you - a c l i n i c a l therapist i n Occupational Therapy. If you have checked the supervising therapist, complete the remainder of the questionnaire in relation to what you perceive YOUR STAFF'S needs and preferences to be. Do not indicate your personal preferences. 1.  There are many reasons why people do not attend continuing education co.urses. Below is a l i s t of common barriers. Choose the three barriers that prevent you/your staff from attending programs and rank them: (1) being the most frequently encountered barrier, (2) the second most frequently encountered barrier, and (3) the third most frequently encountered barrier. (Choose only three.) family responsibilities  transportation  job responsibilities  no appropriate program available  cost  insufficient advance notice  distance  inadequate publicity  lack of time  inconvenient scheduling  other (specify)  2.  There are a number of ways of making learning opportunities accessible to potential learners. Please rank the three formats you/your staff prefer the most in relation to continuing professional education i n occupational therapy. Rank your choices with (1) being the most preferred format, (2) being the second most preferred format, and (3) the third most preferred format. 1 or 2 day workshops  audio tapes  short courses (1-2 weeks)  educational television  evening series (3-6 weeks)  educational radio  travel 1ing consultants  correspondence  otner (specify) 3.  Assuming that educational television were available to you in your home, what type of continuing professional education information would you prefer to be delivered via television? Check only one. basic and applied sciences  c l i n i c a l conditions  occupational therapy s k i l l s and techniques  professional Issues  continued.  SECTION III  In your s t a f f ' s present position (or i n your position) as a c l i n i c a l therapist, what do you consider to be your s t a f f ' s (or your) learning needs? There are 136 competencies required of entry level occupational therapists. Below are l i s t e d 30 competencies that the c l i n i c a l therapist frequently encounters. For each of these statements c i r c l e the appropriate number i n each of the four categories. (1) indicates a low level of competence or relevance, (2) indicates a moderate l e v e l , and (3) indicates a high level of competence or relevance. OCCUPATIONAL THERAPY COMPETENCIES  relevance to your role as occupational therapist IOM - high  existing level of competency  I M - high  desired level of competency  low - hlfh  Is training presently available to you in this area? lo« - high  EVALUATION: 1) Identify and evaluate motor function skills  1  2 3  1  2 3  1  2 3  yes no  1  2 3  1  2 3  1  2 3  yes no  2)  Identify and evaluate perceptual-motor  3)  Identify and evaluate sensory function  1  2 3  1  2 3  1  2 3  yes no  4)  observe and record cognitive function  1  2 3  1  2 3  1  2 3  yes no  5)  Identify and evaluate leisure and play s k i l l s  1  2 3  1  2 3  1  2 3  yes no  6)  i d e n t i f y and evaluate vocational s k i l l s  1  2 3  1  2 3  1  2 3  yes no  7)  identify and evaluate A.D.L. s k i l l s  1  2 3  1  2 3  1  2 3  yes no  8)  Identify and evaluate functional communication skills  1  2 3  1  2 3  1  2 3  yes no  9)  Identify and evaluate psychosocial function  1  2 3  1  2 3  1  2 3  yes no  1  2 3  1  2 3  1  2 3  yes no  THERAPEUTIC PROCEDURES: 10) conduct therapeutic Interviews 11)  select and adopt a c t i v i t i e s for therapeutic purposes  1  2 3  1  2 3  1  2 3  yes no  12)  design and adapt special equipment  1  2 3  1  2 3  1  2 3  yes no  use  OFFICE  ONLY  OCCUPATIONAL THERAPY COMPETENCIES  teievance to | existing level rour role as of competency occupational therapist 1  desired level of competency  Ion • high  THERAPEUTIC PROCEDURES continued...  loo - high  13) employ counselling methods  12  3  14) apply sensory-based therapies to develop perceptual motor s k i l l s  12  3  1 1  15) employ j o i n t mobilization and protection techniques  12  3  16) employ muscle strengthening techniques  1  17) t r a i n 1n work simplification and energy conservation techniques  1 2  3  1 2  3  j1  1 2  3  | 1 2 3  12  3  1 2 3  1 2  1 2  3  1 2 3  18) employ behavior modification approaches 19) employ sodo-drama techniques 20) employ relaxation techniques 21) employ r e a l i t y orientation 22) employ activation methods 23) u t i l i z e recreation and leisure time a c t i v i t i e s  j low - high  2 3  1 12  1  2 3  yes no  1 2 3  1  2 3  yes no  | 1 2 3  1  2 3  yes no  j1  1 2  3  yes no  2 3  yes no  3  yes no  2 3  yes no  3  yes no  1  2 3  yes no  1  2 3  yes no  1 2 3  2 3  1 2  2 3 3  UTILIZATION OF THERAPEUTIC EQUIPMENT AND MATERIALS:  is training presently available to you in this area? low - high  1 1  11  1  3  2 3  2 3  1 2 1  1 2  j1  1  2 3  yes no  1  2 3  1  2 3  1 2  3  1  2 3  yes no  1 2  3  1 2  3  1  2 3  yes no  27) select and u t i l i z e avocational equipment and materials  12  3  1 2  3  1  2 3  yes no  28) select and u t i l i z e vocational equipment and materials  12  3  1 2  3  1 2  3  yes no  29) select and u t i l i z e projective equipment and materials  1 2  3  1 2  3  1  2 3  yes no  30) select and u t i l i z e developmental equipment and materials  12  3  2 3  1  2 3  yes no  24) select and u t i l i z e s e l f care equipment and materials 25) select and u t i l i z e rehabilitation aids and materials 26) select and u t i l i z e mobility aids  j1  2 3  3.  yes no  [ 1 2 3  OFFICE USB  ONLY  APPENDIX B LETTERS OF TRANSMITTAL  APPENDIX C LETTER OF SUPPORT  

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