**Top 12 Things You Should Know For Your Fieldwork**

A list of things to help occupational therapy students prepare or get through their fieldworks/internships in preparation for becoming an independent practitioner.

1. BE PROACTIVE AND REACTIVE. If you have a patient with fragile X syndrome tomorrow, research it in advance. If you see a patient with fragile X syndrome and realize you would benefit from more knowledge or have questions, research it after. Maybe you can present your supervisor with some helpful resources you found, or be better prepared for next time.

2. ASK QUESTIONS, AND KNOW WHEN TO ASK THEM. Supervisors and practitioners of any field are hopefully happy to answer your questions. It’s a great sign that you are processing and synthesizing information. But when you are both with a patient, use your best judgment as to whether it’s an appropriate time to ask it. If in doubt, don’t ask it then. Write it down so you don’t forget or at least scribble a “trigger word” reminder down for later. Bombarding your supervisor with questions at the last second of the day while they hurriedly try to get their act together, isn’t appreciated either. Collaborate on finding a good time to ask the questions.

3. YOU WILL MAKE STUPID MISTAKES AND IT’S OKAY. I’m not talking about safety ones here, I’m talking about basics. Forgetting where you put your pen, or being unable to open a simple container, or bumping into something. You are nervous and on your best behavior and you are trying soooo hard to impress your supervisor. That means you will make the stupidest mistakes of all, and we get it. We were there too. We (likely) aren’t judging you harshly for mistakes that we know are from nervousness.

4. SAFETY COMES FIRST. Stupid mistakes with opening a container are fine, dropping a patient is not. If you don’t feel safe with a patient for any reason (whether it’s for a physical impairment or mental health/cognitive reason), you need to ask for guidance. You may hesitate because you don’t want your supervisor to realize you don’t know how to do something you probably should by now, or to cause them trouble. Guess what? It causes them FAR more trouble, and FAR less confidence in your abilities, if you make a mistake that hurts a patient because you were more concerned about yourself than the patient.

5. HAVE A “CHEAT SHEET”. Common abbreviations, alarm codes, locations, phone numbers, little tidbits of information, whatever. Jot it all down. Keep an index card on your clipboard or in your pocket. When you’re stressed, and you likely will be, you are going to have trouble remembering all the little things you usually don’t have issues with. It’s appreciated when you don’t have to ask your supervisor every 5 minutes for a code they’ve given you twice now.

6. BE EXTRA HELPFUL . Your supervisor will eventually (hopefully) be helped by your presence, but at first, you are an awful lot of extra work, no matter how amazing you are. See something that you can easily put back in place, or clean off, or make more efficient? See a little errand you could run? Offer to do it, or ask permission. You may want to do it without permission but just ensure it’s not something being done deliberately. For example, don’t put away a 100-piece jigsaw puzzle that is laid out, with 6 pieces still undone, unless you are positive it’s not being saved for some reason. Don’t try to organize a drawer of equipment unless you understand its purpose, usage patterns, and knew that someone jumbled it up yesterday but that it looked a specific way the day before.

7. FOCUS ON LEARNING EVEN DURING DOWNTIME AT WORK. If you have any downtime in your work day beyond your legitimate break (haha, good luck) or lunch, you should be actively learning. This is your chance. It’s so tempting to get on your phone a while and veg out during a gap. Maybe sometimes you need it for your mental health or to deal with something. But ideally should be researching, or cleaning, or formulating questions, or updating your cheat sheet, or something that shows determination and drive. Don’t be too zealous and don’t bug your supervisor too much if it’s clear they need a break. But at the very least, ask if there is anything they would like you to do or anything you can do to help, during the downtime.

8. EXPECT AND WELCOME CONSTRUCTIVE CRITICISM. You’re a student, you’re interning, you don’t know everything. You will make mistakes you don’t even know you’re making. Maybe you will talk too loud, or be “too” helpful. (One time I was trying to get my kids to advocate that they need a pencil by giving them a writing task, paper but no pencil, and then deliberately turning away to occupy myself. My shadow jumped up to get it before I could – a perfectly valid thing to do, but I had to give her feedback to wait until I asked since it was often a deliberate act on my part.) Maybe you won’t realize you are insulting a patient with your word choices, or that you keep forgetting to teach a certain skill. The whole point of your internship is to grow. You can’t grow if you aren’t aware, and “you don’t know what you don’t know.” It may sting, especially when you are trying your best and had such good intentions. Try to therefore hold the intent of the person giving you feedback, which is only about making you be even better than you already are. Don’t be defensive. Nod and give appreciative for the feedback.

9. YOUR PLACEMENT/THERAPISTS MAY NOT BE YOUR IDEAL, AND YOU CAN STILL LEARN A LOT. Maybe you really, really, really wanted to do pediatrics, but instead you got a hand specialty. Maybe you have a super stern or um, supervisor with a conflicting personality type, versus the warm/fuzzy one you craved. If there is a true moral/ethical/safety/major concern, speak up to your fieldwork advisor at the school for a potential placement change. If it’s a frustrating/annoying experience, get advice, but realize you are likely in it for the three months if it’s a Level II. You will still learn a lot, even if it’s a lot of what NOT to do, or to work in the face of adversity. A lot of employers ask their potential employees about a time they had a conflict with a coworker, and this will be great for that interview question! Lucky you, right????

10. YOU WILL SOMETIMES FEEL LIKE AN IMPOSTER. It’s okay, we get it. We have all been there. Sometimes we’re still there, when we encounter new situations or change areas of practice. You may feel like you have no idea what you’re doing, but if you are doing it safely, and look confident, and your supervisor, colleagues, and patients are not giving you negative feedback, you’re probably just fine. You will think “gosh, they say I’m doing a good job, but if they REALLY knew how little I know, they wouldn’t say that. I’m just hiding it.” Happy to tell you that you’re probably doing better than you think. Give yourself some credit.

The ten above are pretty universal for all fieldwork students, and the two below are more targeted towards people like me, who have had a long struggle with depression and/or anxiety, and found fieldwork even more challenging than normal, because of it.

11. YOU WILL GET IT EVENTUALLY. This is somewhat similar to the fraud piece. You will likely feel overwhelmed at first, that you will never understand it all, that it’s just way too much, and you will fail. That everyone else can do it, that something is wrong with you, that all your schooling was worthless because you won’t get through the fieldwork. You will be scared. You will be SO CONVINCED it won’t click. But guess what, it will and does. It takes at least a week to start to get a picture of anything, and by the end of the second week you’ll have so much more knowledge than you would have guessed, although a lot of it you may not even give yourself credit for. With every week, more and more scaffolding will help you learn. Unfortunately, at the same time, they’re increasing your independence, so it’s somewhat of a balancing act in terms of anxiety. Keep telling yourself out loud, over and over and over again, whether you believe it or not, that you will get through it. Because you will. It’s a miracle, I’m hardly even exaggerating for once, that I made it through. I’m a great masker, nobody at work truly knew the extent of it. But I did it. YOU WILL TOO. AND IT IS WORTH IT. Because once you’re out of fieldwork, you can go into what you WANT to go into. You can do what feels comfortable, you can work without necessarily feeling like someone is watching you intently, you can start to relax. Which leads to…

12. USE YOUR RESOURCES. This may be your exercise/yoga class, a meditation session or church, a good friend, family, a hobby, the Internet/social media, mentors, textbooks, whatever. Something that gives you confidence in your knowledge, or lets you decompress/relax, or gives you support in whatever form you need. This can also include a psychologist and/or a psychiatrist. I would not have gotten through fieldwork, 100% for sure, without many of these resources, and most especially a psychologist and psychiatrist. Not something I should ideally mention to the world, and many of you people over the age of 35 or so will grimace that I admit it publicly (different perceptions of privacy), but IT IS SO IMPORTANT for people to realize how prevalent it is, and that only happens if people admit it. Yep, I struggled a lot in fieldwork, mostly due to the anxiety disorder. And yes, it was all worth it. And I’ve been a practitioner less time than many of my coworkers because of needing breaks, but I’m on my fourth year now of being a practitioner. And I love, love, love, love being an occupational therapist. And I would do the entire process all over in a heartbeat, even though it nearly killed me at times. IT WAS WORTH IT. If you have passion for the field, and you ARE WILLING TO ADMIT YOU NEED HELP in whatever form that takes (yoga, friends, counseling, any of it), you have a high probability of success.

By the way, I’ve written a little about OT Student fears in the past, and some ways to impress your professors, and if you go to my archives, I wrote roughly a thousand posts in OT school during 2006 to 2009.

Click “Read More” for the rest of the information, which may be helpful to prospective students who have no idea what I am talking about when I reference Level I and Level II fieldworks. 🙂 

I was thinking about occupational therapy students and fieldwork earlier today and how I should do a post, and then I saw that the American Occupational Therapy Association (AOTA) posted about this very topic on their public Facebook page today! It’s their current status on 6/17/14. They also link to “Surviving Fieldwork” on OT Connections (otconnections.aota.org) but I think that one might only show up for members.

Occupational therapy students undergo a rigorous didactic program as well as “Level 1” fieldwork. This is short-lived and done throughout each didactic semester as a way to expose students to the “field” of occupational therapy. Students have already had an abundance of exposure to OT as it requires a significant number of volunteer and/or observation hours before admission, but there is a massive transformative shift in the amount of educational scaffolding that has taken place by the time you start a Level I internship. It’s a time to take all the theory you’ve been learning and see it applied in practice, as well as potentially contribute. It also lets you see how things work in the “real world” and come back into the theoretical session with a better understanding of why it’s being addressed.

Level I fieldworks can be nerve wracking, as is any new experience, but Level II fieldworks are where it can get intense! Level II fieldworks typically vary between 6 to 9 months of full-time internship, and it looks different in every program as to how it’s implemented. At my graduate school in Memphis, TN, way back in the old ages of 2008/2009, we had three, three-month rotations. So 9 months of full-time fieldworks to prepare us for being independent practitioners. By the end of each rotation, we had a full caseload and worked as if we were practitioners, except that we had a supervisor who signed off on our notes and ensured we were providing high level quality of care in all the forms that can take (safe, evidence-based, inclusive, good relationship, detailed, etc).

At my school we had to do one specialty (ie pediatrics, hands, trauma, etc), one physical dysfunction, and one mental health rotation. How those rotations went is it’s own article! For now, I want to focus on the more generic aspects of fieldwork/internships. What you will hear bosses say, when considering someone for employment, is that it’s often not about knowledge, it’s about character. It’s about what is teachable versus not. They would often rather hire a new graduate with an amazing passion, thirst for knowledge, charismatic attitude, and team player, then a knowledgeable therapist with 20 years of incredible experience who has a challenging personality, little warmth or relationships with clients, and no desire for learning new methods. You can teach knowledge, you can’t teach compassion. The inexperienced graduate will often win out because she doesn’t need to be taught the unteachable components of humanity. She can learn the rest and clearly has the desire and capacity to learn it. (Sorry to keep using she, I know plenty of “he” therapists, but it gets so awkwardto deal with he/she language…I use they a lot. Blah blah blah, sorry grammar teachers…and mom).

There is a similar philosophy to fieldwork and how a practitioner/supervisor will perceive your competence. Yes, all that knowledge you sometimes dutifully studied in graduate school, is (cough usually) important. 🙂 The theory you have learned is why you will be such a great practitioner, because the “why” is usually more important than the “how”, in initially figuring out an approach. But your level of knowledge, while it may impress your supervisor, is ultimately NOT what will be their primary deciding factor in how much potential you have. It’s actually about what comes before the knowledge, what inside of you holds your knowledge, and this is true for ANY fieldwork student or ANY intern, anywhere. Please look at the list above and see what you think. There are of course many more variables, so share your thoughts, I’m sure fieldwork students will be appreciative. Hopefully they can contribute as well. By the way, if you go through my blog archives, I do talk quite a bit about Level I and Level II fieldworks (within HIPPA guidelines) throughout the 2006 to 2009 years, when I was in graduate school. It may be helpful for prospective or current OT students.