The Once and Future Programme:
Educational innovation in occupational therapy

CANADIAN JOURNAL OF OCCUPATIONAL THERAPY VOLUME 63 NO 1

by Muriel Westmorland, Penny Salvatori, Mary Tremblay, Bonny Jung,
Adele Martin

In 1977, the first college-based occupational therapy diploma programme in Canada began at Mohawk College of Applied Arts and Technology in Hamilton, Ontario. The programme, offered in conjunction with McMaster University, was one of the first occupational therapy programmes in the world to use problembased, self-directed learning methods. The programme's curriculum emphasized the preparation of occupational therapists who would be able to meet the changing health care needs of Canadians and to be effective lifelong learners, actively involved in the ongoing process of their education throughout their professional careers.

Throughout its 15 years of existence, the Mohawk College Programme received considerable interest because of its innovative curriculum and the established competence of its graduates. It also received significant criticism because of its primary location outside of a university. While the programme had been approved by the Ontario Ministry of Colleges and Universities and the Ontario Ministry of Health, it had not been sanctioned by the Canadian Association of Occupational Therapists (CAOT). This paper discusses the programme's philosophy and educational model and demonstrates how these were subsequently incorporated into the new McMaster University programme, "a once and future'' programme (White, 1958).

DEVELOPMENT OF THE CURRICULUM

The planners of the Mohawk College Occupational Therapy programme identified a number of challenges as they began to design a curriculum in the mid-1970s. The central questions they addressed were: How should occupational therapy be defined in a period of change in Canada? What knowledge, skills and attitudes should be addressed in the curriculum? Could a curriculum be developed that "would educate a professional to anticipate and adapt to change throughout a professional career" (Cooper, Dolyniuk & Westmorland, 1982).

Between 1977 and 1980, programme faculty explored the literature on educational theory and developed their own specific philosophy of occupational therapy. The educational philosophy of the programme was based on the concepts of active learning developed by Piaget (1984), Bruner (1966) and Rogers (1969), the adult learning philosophy and self-directed learning ideas of Knowles (1975a), and the problem-based learning and clinical problem-solving approaches developed in the new McMaster undergraduate medical programme (Spaulding, 1991).

 

The principal goal of education is to create people who are capable of doing new things, not simply of repeating what other generations have done — people who are creative, inventive and discoverers. The second goal of education is to form minds which can be critical, can verify, and not accept everything they are offered. The great danger today is of slogans, collective opinions, readymade trends of thought. We have to be able to resist individually, to criticize, to distinguish between what is proven and what is not. So we need pupils who are active, who learn early to find out by themselves, partly by their own spontaneous activity and partly through materials we set up for them; we learn early to tell what is verifiable and what is simply the first idea to come.(Piaget, 1974, p.29)

The programme's philosophy of occupational therapy evolved from both the historical roots of the profession and the health needs of Canadians (Lalonde, 1974) and focused on occupational roles and functions within the context of human development, health, illness and disability:

 

Occupational therapy believes that a healthy lifestyle is based on a balance between work, play and social relationships and the ability to care for one's personal self and to effect one's environment. Throughout life, man assumes many different roles, friend, worker, mate, student, hobbyist, and his ability to fulfill these roles to his potential and to balance these roles is essential for health.

Illness, injury or disability can interfere with man's ability to function in a healthy lifestyle. Occupational therapy believes that each individual should have the right to live a healthy lifestyle and thus maintain the various occupational roles throughout life. The knowledge, skills and values of occupational therapy have focused on provision of assistance to individuals and groups to gain/regain their ability to function throughout life. Provision of assistance is related to the individual's home, work or social environment. This might include adaptation of work or home environment, development and training in a variety of work, leisure and/or daily living skills and counselling in coping and adapting to the effects of illness and disability and in the promotion of a healthy lifestyle. (Mohawk College, 1980, pp. 2-3)

The educational philosophy and design of the curriculum addressed the new emphasis in the occupational therapy literature during the 1970s on the development of clinicians who were skilled in problem solving. "Occupational therapists must approach each new situation as an opportunity or challenge to find meaningful solutions to the problems facing the patients or clients with whom they are working" (Hopkins & Smith, 1978, p.109). Llorens also argued that: "Practising occupational therapy is a complex task. It defies simple equations and purely technical handling in terms of problem resolution. It is an art based upon scientific knowledge". (Llorens, 1976 p.3)

This problem solving approach complemented the programme philosophy of occupational therapy as envisioned by the Mohawk College faculty and clinical instructors and reflected the McMaster Health Sciences model of problem-based self-directed learning (Spaulding, 1991). The programme's philosophy of occupational therapy guided the development of specific programme goals.

Table 1 Goals of the Occupational Therapy Programme

The graduate will be able:

  • To identify the biological and behavioural components of health, illness and disability and their relationship to man and society.

  •  

  • To describe historical perspectives of occupational therapy profession and present theoretical basis of occupational therapy practice.

  •  

  • To acquire and apply the theory and concepts of occupational therapy and other related fields in clinical practice.

  •  

  • To develop occupational therapy clinical skills and methods required to define and manage health problems of patients, and to select appropriate tools for assessment and management of these problems.

  •  

  • To communicate effectively with individuals and groups.

  •  

  • To function as a member of a group which is engaged in health care, learning or research.

  •  

  • To develop effective learning skills which will enable the graduate to continue to learn and develop throughout life.

  •  

  • To recognize and develop personal characteristics required for professional life; these include: (a) ability to relate and respect each individual's uniqueness and human rights, (b) ability to develop and construct empathetic relationships, (c) demonstration of respect for self and profession.

While identification of programme goals had been relatively straightforward, the process of identifying the specific knowledge, skills and attitudes that should be addressed in the curriculum, became overwhelming as planners and clinicians each strove to include their own areas of interest and practice within the curriculum. The planners reviewed a variety of curriculum models and guides in occupational therapy and began to recognize that it would be impossible to teach students all aspects of knowledge, skills and behaviours that they would need throughout their professional careers (Bridle,1978). As Bruner stated:-

 

A curriculum reflects not only the nature of knowledge itself but also the nature of the knower and of the knowledge-getting process. We teach a subject not to produce little living libraries on [a] subject, but rather to get the student to think for...himself... to take part in the process of knowledge- getting. Knowledge is a process not a product. (Bruner,1966 pp.72)

The educational philosophy of the programme also recognized the importance of developing life-long learning skills to enable graduates to continue to meet the rapidly changing health care system. It emphasized the importance of developing the students' ability to analyze their own learning needs as well as the ability to develop strategies to acquire the knowledge, skills and behaviours needed for professional practice. In addition, the philosophy promoted the importance of students evaluating the quality of their own learning to ensure their ongoing competence in future professional practice. The work of Knowles on adult learning and self-directed learning (1975b) provided the pedagogical rationale for the small-group, problem-based tutorials and the clinical fieldwork component of the programme.

The final curriculum model consisted of nine semesters of coursework and clinical fieldwork spread over 33 months (three years). The educational format was a combination of teaching and learning approaches, that included problem- based learning, small group tutorial learning, clinical practice labs, contract learning and a variety of experiential learning activities. The curriculum included traditional courses in the basic physical sciences such as physics and chemistry, and the social sciences including psychology, sociology and anthropology. Students attended McMaster University for courses in anatomy and physiology which had been designed specifically for them and where they were able to use McMaster's innovative anatomy learning resources. McMaster faculty served as the prime instructors for these courses and also served as guest lecturers and resource people for other courses.

The professional content of the curriculum was delivered in three major streams. The first stream, Occupational Therapy Integration, emphasized the understanding and application of occupational therapy history and theory. Level I and II introduced the historical and theoretical bases of the profession, concepts of health, illness and disability and the human developmental process. Occupational Therapy Integration III, offered in the final semester of the programme provided the students with an opportunity to identify their future theoretical basis of practice.

In the second stream of the programme Problem Based Tutorials, students used health care problems to acquire and integrate knowledge, skills and attitudes needed for professional practice. Level I focused on:

 

The understanding and development of problem solving skills, and the use of learning methods and resources...it introduce[d] the student to the concepts and practice of occupational therapy through the exploration of health care problems. Level II emphasized the acquisition and integration of knowledge related to biopsychosocial concepts of health and illness and the general practice of occupational therapy. Level III provide[d] opportunities for the student to acquire and integrate knowledge in relation to the specialized practice of occupational therapy. (Mohawk College, 1975, p.2)

Students were encouraged to try out a number of problem solving models drawn both from medicine and the social and behavioural sciences. Over 70 health care problems were developed, many designed with assistance from clinicians. These included paper and audio-visual problems, simulated patients and clinical problems packaged like a deck of cards (P-4 Decks) that led students through the clinical reasoning process. Problems were evaluated by students at the end of each course and changes were made based on feedback.

Initially the faculty believed that the problem-based tutorials would be best offered in the third semester of the programme, after the students had two semesters of introductory courses. However, after several years of positive student feedback on the importance of problem based learning, the curriculum was revised to offer problem-based learning in the first semester of the programme, in the anatomy course. Tutors were drawn from the occupational therapy faculty and clinicians and worked with McMaster faculty to offer one tutorial per week, during the first three semesters of the programme.

The third stream of profession-specific courses focused on the development of occupational therapy assessment and treatment skills using hands-on techniques in a clinical laboratory setting. Whenever possible, health care problems and simulated patients (people who are trained to physically and emotionally emulate real patient problems and who are prepared to provide feedback to students) were used to facilitate learning. Clinical experts from a variety of clinical settings provided hands-on instruction either at the school campus or in clinical settings. Objectives were integrated whenever possible between the clinical skills labs and the Clinical Problem Solving courses. The Mohawk College Programme used a variety of evaluation methods. Written examinations such as multiple choice exams, short answer tests and essay-type exams were used to assess knowledge. Research papers and/or problem write-ups were used to assess knowledge, critical appraisal skills and to develop the skill of scientific writing. Papers on specific health care problems served to integrate knowledge and problem-solving skills as well as the student's ability to use a variety of resources.

A triple jump evaluation was developed. This consisted of a three-part oral exam that was used to evaluate the student's knowledge, clinical reasoning skill, integration and time management in relation to a specific patient problem. During the first part of the exam the student was given a clinical problem and had to identify issues related to the clinical case and occupational therapy management. Faculty provided additional data in response to students' questions. At the end of this first part students identified their learning needs and where they would look for resources. When the students returned (after a period ranging anywhere from 4 to 48 hours depending on the course) they had to integrate their new learning into a re-formulation of the clinical problem. During the third part students presented an occupational therapy management plan based on theory and outlined their goals and objectives. Where possible treatment efficacy must also be included. This structured oral selflearning exercise provided an opportunity for the tutor to evaluate the individual students' clinical reasoning abilities, research skills, ability to think on their feet, and integration of theory with practice. (Chapman & Westmorland 1993).

Clinical occupational therapy skills examinations served as a summative method of evaluation, to determine the student's competency in occupational therapy interviewing, assessment and/or treatment skills, using standardized or volunteer patients. These exams provided the opportunity for direct observation of clinical skills and were followed by an oral or written component to evaluate the student's ability to synthesize information and draw appropriate conclusions.

Student performance in small group tutorials or small group sessions was assessed using self, peer and tutor evaluation to determine the student's ability to function effectively as a group member. Direct observation of a student's performance in clinical skills served to provide the student with immediate feedback on interpersonal and clinical skills following a patient encounter. These techniques were particularly useful for assessing clinical competence in fieldwork settings. Self-evaluation methods were used to encourage students to examine their individual performance in class, clinical and small group settings. The ability of students to evaluate personal strengths and weaknesses and identify learning skills necessary for future practice, was seen critical to the development of occupational therapists as lifelong learners.

FACULTY AS CRITICAL RESOURCES

Core faculty were small in number and were drawn from senior clinicians who had obtained Master's Degrees and had clinical expertise in paediatrics, adult physical medicine and rehabilitation, community occupational therapy and psychiatry. Faculty spent much time in the early development of the Mohawk College Programme discussing educational philosophy, curriculum design and the educational preparation of the occupational therapist of the future. Faculty valued theory as a critical basis for occupational therapy practice and emphasized its importance throughout the Mohawk College Programme.

LINKS WITH THE CLINICAL COMMUNITY

Recognizing that education programmes for a clinical profession needed to have close links between its practitioners and its educators, the programme encouraged and supported collaborative partnerships with clinicians in all aspects of the programme. In the developmental phase, clinicians were involved in many roles: sitting on the advisory committee; advising on admission criteria; serving as interviewers in the student selection process; advising on space arrangements and laboratory equipment; providing feedback on the curriculum; developing health care problems for problem-based tutorials; and training simulated patients. In the operational phase, clinicians were involved in a variety of educational roles: clinical skills instructor; lecturer; fieldwork supervisor; tutor in the clinical problem-solving and management courses; evaluators in oral and clinical exams (Edwards 8c Martin,1989) and resource persons for students.

Another innovative approach in the building of meaningful links with the clinical community was the development of the Clinical Instructor position at five Hamilton clinical facilities. This role was initially modelled on the role that had been developed in the physiotherapy programme in 1971 (Dardier, 1975). As the occupational therapy programme developed, the role was modified to complement the occupational therapy curriculum.

The Clinical Instructor position had three main components that contributed to its uniqueness: academic responsibilities in the school setting (teaching clinical skills labs or tutoring), clinical teaching in the clinical setting, and the maintenance of an active clinical practice.

Clinical Instructors were integral members of the Clinical Education, Curriculum and Promotion Committees of the Mohawk Programme and contributed on all levels to the development of the curriculum.

In the clinical teaching role, Clinical Instructors provided a liaison between the College and clinical facilities and co-ordinated student activities within clinical facilities. These activities included organization of the general orientation programme, reviewing the roles and responsibilities of the student and clinical preceptor, assistance in developing the learning contract; supervision and/or instruction of the student in the clinical setting in collaboration with the clinical preceptor to whom the student was assigned, monitoring progression of the student's clinical performance and involvement on midterm and final evaluation. Clinical Instructors provided ongoing consultation and support to the clinical preceptors as well as the students.

Finally, the fact that all Clinical Instructors had active clinical practices, provided a balanced, real world aspect, that complemented their academic role. This reality also provided important role-modelling for students.

CLINICAL EDUCATION

One of the challenging aspects of the Mohawk Programme, was the provision of 1200 hours of clinical education, a major requirement of the Canadian Association of Occupational Therapists Educational Accreditation Standards, to which the programme wanted to adhere despite the position of CAOT. The initial programme faculty had recognized that fieldwork placements for the Mohawk occupational therapy students could not be established at the expense of existing placements utilized by other occupational therapy programmes (both within Ontario and other parts of Canada). While the clinical facilities within the Hamilton region supported the programme, many clinical facilities outside the region refused to provide fieldwork placements for the Mohawk students. These two situations posed some constraints on the development of clinical education sites. However, the faculty used this situation to develop new types of student placements within the emerging community health care programmes of the late 1970s. As a result of these efforts, clinical placements were established within home care programmes, residential care programmes, industrial settings and community-based social service programmes in Hamilton that had not previously provided clinical education in occupational therapy.

The jointly funded clinical instructor position with the Hamilton-Wentworth Home Care programme was one of the first positions of this type in a community-based setting in Canada. Community programmes that did not have staff occupational therapists but whose clients could benefit from occupational therapy, were also used for student placements, with faculty providing student supervision. Some of these experiences resulted in the development of permanent occupational therapy positions within local clinical facilities, such as the Kidney Dialysis Unit at St. Joseph's Hospital and the March of Dimes, both in Hamilton. International occupational therapy programmes were also approached for senior level clinical placements. The first placements in England were found to be mutually beneficial to both students and clinical supervisors. Supervisors commented on the students' problem solving and critical appraisal skills, as well as their ability to use the literature to obtain information and to verify hypotheses. International student placements were gradually expanded to include Israel, Holland, Australia, India, and Barbados. Students were offered the choice of an international placement usually for the final semester of the programme.

Clinical fieldwork in the Mohawk Programme was designed and developed in conjunction with the clinicians in the Hamilton area and placements were designed to support the student to continually develop knowledge, skills and attitudes in occupational therapy practice. Clinical placements were viewed as part of the educational continuum. This essential component of education allowed students the opportunity to put theory into practice by emphasizing clinical reasoning, problem-based learning, and self-directed learning in the clinical setting.

Fieldwork was organized in two parts. In the introductory two semesters of Year Two, students spent two full days per week under the supervision of a clinical supervisor while completing academic courses for the remaining three days. The final four semesters of the programme had seven to nine week academic sessions followed by six week full-time placements.

A student-centred learning contract was used as a major objective setting and evaluative tool. Students were expected to begin this process by developing a semi-structured mini contract at the end of year two and by year three were developing their own personalized detailed contracts.

The learning contract incorporated broad clinical objectives with individual student learning objectives and was specific to each setting and each student. This document guided the learning process throughout the clinical placement. Consistent with the school's philosophy to promote self-direction in the student, the learning contract was a tool which emphasized the student's ability to assess personal performance and to design and implement learning plans to meet individual needs. It allowed the student to own his/her learning and to be instrumental and responsible for developing a critical path.

CURRICULUM REVISION AND PROGRAMME EVALUATION

As part of the philosophy of self-directed learning, students were encouraged to actively evaluate all aspects of the curriculum. The evaluations focused on the strengths and weaknesses of the courses, and on students' ideas for curriculum revision. This active involvement of students was important in shaping the curriculum over the years.

A formal evaluation, using an exit survey, was also used in the first several years of the programme. Students were surveyed at the end of each academic year, at graduation and one year following graduation. The results of these surveys showed that students felt the major strengths of the programme were self-directed learning, small group learning, the variety of clinical practice settings and the use of clinicians for teaching. The weaknesses were: limited application of physics and anatomy throughout the programme; heavy course load and limited opportunity for skill development (Dolyniuk,1981).

Since problem based learning had not been used previously in occupational therapy, many clinicians and students were initially skeptical about its value. The results of the student surveys were important in demonstrating the success of problem-based learning. As more students and clinicians gained experience with problem based learning, it became the most recognized strength of the programme.

THE BACHELOR OF HEALTH SCIENCES DEGREE COMPLETION PROGRAMME

Because of the decision by CAOT to only accept the baccalaureate degree as the criterion for eligibility for membership in the Association, Mohawk College and McMaster University supported the development of a Bachelor of Health Sciences Degree Completion Programme. The Bachelor of Health Sciences (Degree Completion Programme) began in September, 1981. A member of Mohawk faculty was seconded to McMaster University with a cross-appointment in the Department of Medicine to act as the programme chair.

The BHSc Programme was offered on both a part-time and full-time basis. It was designed as an optional interdisciplinary degree completion programme, specifically for Mohawk College diploma graduates in Occupational Therapy and Physiotherapy. Mohawk College graduates in Occupational Therapy and Physiotherapy were granted 75 units of advanced credit towards the baccalaureate degree in recognition of McMaster University's academic input into the Diploma Programme. The BHSc degree programme consisted of four required fourth year level courses and two elective courses drawn from third or fourth year courses offered by the university. The required courses were designed to increase the students' ability to understand and analyze the health care needs of clients, the role of their profession within the health care system and specific areas of clinical practice.

Students could be admitted to the degree completion programme directly following graduation from Mohawk College or after several years in clinical practice. In 1981, 29°/o of the Mohawk graduates proceeded immediately to complete the McMaster degree. However, the percentage of Mohawk graduates who directly entered the BHSc programme following graduation, steadily increased to over 90% enrolment between 1984 and 1991. It is important to note here that in 1984 CAOT submitted its accreditation report of the combined Mohawk and McMaster Occupational Therapy programmes and granted full accreditation to the combined programmes for five years, until 1989.

Thus students saw the degree completion requirement as critical to ensuring them the opportunity to practice throughout Canada.

RETHINKING THE FUTURE

In 1985, a task force was established by Mohawk College and McMaster University to review the organization, curriculum and structure of the occupational therapy and physiotherapy diploma and degree completion programmes. The Task Force on Occupational Therapy and Physiotherapy Education in Hamilton was asked specifically to recommend to the Mohawk/McMaster Health Sciences Liaison Committee methods to:

 

  • Provide the best possible educational experience for occupational therapy and physiotherapy students in Hamilton.

  •  

  • Reduce the time commitment of students to that typical of other Canadian four-year professional programmes.

  •  

  • Ensure optimal use of resources.

  •  

  •  Ensure that the diploma plus degree package meets the accreditation standards of relevant professional bodies (Mohawk College and McMaster University, 1985,.p.1).

In November of 1985, the Mohawk/ McMaster Task Force presented its report to the two institutions. Input had been provided by alumni, students, faculty, members of the Mohawk College Advisory Committees, and the clinical department directors. The Health Sciences Liaison Mohawk/McMaster Committee accepted the recommendations in the report that McMaster University "establish two new baccalaureate programmes in Occupational Therapy and Physiotherapy to meet the requirements of the two professions..." (Mohawk College and McMaster University, 1985).

DEVELOPING AN OCCUPATIONAL THERAPY AND PHYSIOTHERAPY SCHOOL AT MCMASTER UNIVERSITY

Following the Mohawk College Board of Governors decision to phase out the diploma programmes in occupational therapy and physiotherapy in 1986, a planning group was formed, that consisted of the Head of the Division of Occupational Therapy and Physiotherapy, the Chairs of the Mohawk Diploma programmes, the Director of the BHSc (Degree Completion) Programme, and the Research Coordinator for the Division. Additional group members included one of the founding faculty members of the undergraduate medical programme, the Vice- President of Health Sciences and the senior administrative officer of the Faculty of Health Sciences.

Early in 1987, the Undergraduate Council and the Senate of McMaster University approved a proposal for two new second degree undergraduate programmes in occupational therapy and physiotherapy. These programmes were designed for applicants who had already completed a baccalaureate degree and wished to pursue a career in occupational therapy or physiotherapy. Discussions with the Canadian Physiotherapy Association and the Canadian Association of Occupational Therapists and a survey of other Canadian programmes had shown a need for this type of programme. Many applicants already possessed a first baccalaureate degree and existing university programmes were unable to grant sufficient advanced standing to these students. The new McMaster second degree undergraduate programmes, however, would allow students to complete their professional education in two calendar years, an important consideration during a period of serious shortages in both professions (McMaster University, 1987).

The new programmes included a unique Northern Studies Stream, a joint initiative between Lakehead and McMaster Universities. The Northern Studies Stream was designed to provide the opportunity for students to receive part of their professional education and/or clinical training in Northwestern Ontario. It offered students a unique opportunity to live and work in a northern community.

The programme proposal for occupational therapy and physiotherapy was submitted to the Ontario Council of University Affairs in August, 1987 and received approval in 1988. The first class of students was admitted to the new McMaster programmes in September 1990. This resulted in the continuous output of graduates in Hamilton with the last convocation from the diploma/degree programme in the spring of 1992 and the first convocation from the new BHSc Programmes in the fall of 1992.

THE FUTURE PROGRAMME

 In designing the new curricula, the core planners drew on the expertise of the Mohawk and McMaster faculty. They sought to preserve the strengths of the diploma/degree programmes and use the design of new curricula as an opportunity to address some areas of concern in the old Mohawk programmes. As stated in the Curriculum Guide, "The development of the curricula was based on the strengths of the highly respected Mohawk College diploma programmes in occupational therapy and physiotherapy which have been in operation in Hamilton Ontario since the 1970s" (McMaster University, 1990 p.3). The strengths of the Mohawk Programme had been identified by students, faculty, clinicians and employers as problem- based learning, problem solving, small group learning, self-directed learning, clinical skills training and strong community links. All of these themes became central to the process of curriculum development at McMaster and were further strengthened in the new programmes. The B.H.Sc. Curriculum Guide (McMaster University,1990), stated :

 

The curricula ... emphasize(s) that the process of learning is equal in importance to the content. The learning methods are therefore based on the philosophies of self-directed and problem-based learning ... The philosophy of problem based learning stems from the premise that acquisition of new knowledge requires activation of prior knowledge and that knowledge is best remembered in the context in which it is learned. Therefore throughout the programme, students are presented with a variety of problems carefully designed and selected for each curriculum block. These problems may be used in tutorials, clinical skills laboratories, inquiry seminars or clinical education. The problem scenarios promote the underlying biological, physiological, behavioural and environmental determinants of health and the role of health care professionals. The problem scenarios also require the integration of previous learning with the acquisition of new knowledge, skills and attitudes. The problems are designed to provide a context that resembles the future professional context as closely as possible. Problem-based learning incorporates self-directed learning, clinical reasoning and critical appraisal of evidence. (pp.12, 13)

Problem-based tutorials (an integral part of the Mohawk College Programme) became a major part of the new Occupational Therapy programme at McMaster. However, unlike the former programme, where traditional courses in anatomy and physiology were considered core curriculum, students (with the help of faculty) direct their own learning and select which areas they want or need to pursue. Once again the programme drew on the expertise of resource people in the Faculty of Health Sciences and community clinicians who play a major role in the Clinical Skills Laboratories, and provide professional role models for students.

The McMaster University Occupational Therapy curriculum also used the developmental model and after the initial introductory unit in term one, a unit in child health and a unit in adult physical health followed, during the first year. The second and final year developed units on aging and health and adult mental health. The last unit was seen as an integrative unit with occupational therapy and physiotherapy students learning together.

Clinical Education or Fieldwork as it is now called, also followed the Mohawk model of six week blocks. Under the new shortened programme structure however, a clinical phase-in period of two days a week was not possible and after some initial observational visits to facilities in unit 1, students experience their first clinical placement in the child health unit. The final unit (VI) is followed by a clinical fieldwork component. Learning contracts are again used in the B.H.Sc. Occupational Therapy programme and the university continues to provide annual workshops for clinical preceptors.

A number of the Mohawk College faculty were recruited by the university. Community clinicians who were involved in the Mohawk Programme as tutors, lecturers and clinical supervisors were asked to continue to fulfill similar or new educational roles within the new programmes. Many of these clinicians have been offered part-time or professional associate appointments within the newly established School of Occupational Therapy and Physiotherapy at McMaster University.

CONCLUSIONS

The new B.H.Sc. (occupational therapy) Programme at McMaster has not only been built upon the strengths of the Mohawk programme but has also benefited from the additional strengths of a university environment e.g. opportunities for research, collaboration with other disciplines (sociology, epidemiology). The university has also benefitted from the educational expertise of the occupational therapy and physiotherapy faculty who have contributed to the faculty of health sciences on educational development committees and workshops related to problem based learning and evaluation as well as continuing to contribute to workshops related to the role of the Clinical Preceptor. The Once and Future programme in occupational therapy in Hamilton, has developed a strong educational base rooted in both the academic and clinical community and has a history of responding to challenges in innovative ways. It will continue the commitment to innovation in education into the next millennium in Canada.

REFERENCES

Barrows, H.S., 8c Tamblyn, R.M. (1980). Problem based learning : An approach to medical education. New York: Springer Publishing.

Bridle, M. (1978). Profile of an occupational therapist: A report on the project to date. Canadian Journal of Occupational Therapy 45, 23-25.

Bruner, J. (1966). Toward a theory of instruction, pp.72 Cambridge, MA: Harvard University Press.

Cooper, B., Dolyniuk, M., & Westmorland, M. (1984). The use of problem based learning in an occupational therapy curriculum. In H. Schmidt 8c M.

DeVolder, (Eds.), Tutorials on Problem Based Learning, Volume 2, Assen/Maastrict: Van Goreum.

Chapman, J. & Westmorland, M. (1993) The structured oral self-learning exercise: An example of student centred evaluation. Medical Teacher, 15, 2, 162-163.

Dardier, E. (1975). A certificate programme for clinical instructors. Physiotherapy Canada, 27, 196-197.

Dardier, E. (1981). Mohawk College physiotherapy programme. Physiotherapy Canada, 237-239.

Dolyniuk, M. (1981). Mohawk College exit survey (Unpublished document).

Edwards, M., 8c Martin, A. (1989). The objective structured clinical examination as a method of occupational therapy student evaluation. Canadian Journal of Occupational Therapy 56, 128-131.

Hopkins, H.L., 8c Smith, H.D. (Eds). (1978). Wi llard Spackman's occupational therapy (5th ed.) (p.109). Philadelphia: J.B. Lippincott.

Knowles, M. (1975a). The modern practice of adult education: Andragogy versus pedagogy. New York: Association Press.

Knowles, M. (1975b). Self directed learning: A guide for learners and teachers. New York: Association Press.

Lalonde, M. (1974). A new perspective on the health of Canadians: A working document. Ottawa: Ministry of Supply and Services.

Llorens, L. (1976). Application of developmental theory for health and rehabilitation (p. iii). Bethesda, MD: American Occupational Therapy Association.

McMaster University. (1985). Report of the task force on occupational therapy and physiotherapy research. Hamilton, ON: Author.

McMaster University. (1987). Proposals for baccalaureate programmes in occupational therapy and physiotherapy offered by McMaster University in co-operation with Lakehead University. Hamilton, ON: Author.

McMaster University. (1990). Curriculum guide: B.H.Sc. occupational therapy and physiotherapy programmes. Hamilton, ON: Author.

Mohawk College 8c McMaster University. (1985). Mohawk/ McMaster health sciences task force report on occupational therapy and physiotherapy education in Hamilton. Hamilton, ON: Author.

Mohawk College. (1975). Occupational therapy programme: Level one handbook (p.3). Hamilton, ON: Author.

Mohawk College. (1980). Occupational therapy programme: Curriculum guide, 2. Hamilton, ON: Author.

Piaget, J. (1984). In D. Elkin (Ed.), Interpretative essays on Jean Piaget (p.29). New York: Oxford University Press.

Rogers, C. (1969). Freedom to learn. Columbus, OH: Charles E. Merrill Publishing.

Spaulding, B.B. (1991). Revitalizing medical education: McMaster medical school the early years 1965-1974. Hamilton. ON: Decker.

White, T.H. (1958). The once and future king. Glasgow: William Collins Sons.