TWU Occupational Therapy Doctoral Capstone Student
as part of her Capstone Project:
Development of Pedagogical Resources on Diversity, Equity, and Inclusion for Occupational Therapy Faculty
Co-mentored by Dr. Dayton Kinney,
Coordinator of Teaching, Learning, & Academic Excellence
Diversity, Equity, and Inclusion (DEI) is an institutional and multi-faceted initiative based on the concepts that comprise its name. DEI’s relevancy will continue in today’s ever-changing social environment as shown by the 133 minority members of the 118th Congress, which has nearly doubled in the two decades since the 108th Congress of 2003-05, which had 67 minority members (Schaeffer, 2023). Yet, despite efforts to advocate and implement DEI initiatives in higher education for the aim to create systemic change, historically marginalized communities still struggle for acceptance and respectful interactions. In fact, as of 2020, 81% of Black adults say being Black hurts a person’s ability to get ahead in the U.S. at least a little, up from 68% in 2019 (Mitchell, 2021). With this continued struggle in mind, it is imperative for healthcare institutions and professionals to do their part by staying informed of current needs concerning areas of DEI.
DEI’s Influence on OT Pedagogy
Occupational Therapy (OT) is a healthcare field in which DEI needs to be embedded into the curriculum, because OT practitioners work with people of diverse backgrounds that extend beyond the preparation provided by the current literature. According to the U.S. Census Bureau (2021), 40.7% of the U.S. population identify as racial or ethnic minorities. Therefore, because of the high likelihood of an OT practitioner working with diverse cultural groups, it is crucial for educators to be knowledgeable and comfortable when teaching students how to be culturally responsive practitioners, as well as have the necessary resources. Through a review of literature describing the current presence of DEI in OT curriculum, a common theme was found within the studies: the limited evidence of DEI education. All studies found a gap for a comprehensive analysis of current instructional practices, whether it was the methods or efficacy of multicultural training practices (Brown et al., 2011), anti-racist instructional practices (Sterman et al., 2022), pedagogical practices and paradigms used by OT educators (Grenier et al., 2020), type of LGBTQ+ clinical preparation provided by OT programs (Bolding et al., 2020), or a need for graduate programs to include cultural competency education into curricula (Matteliano & Stone, 2014). These gaps in the literature suggest that current OT instructional practices may not be effectively preparing students. Consequently, they may contribute to health disparities and inequities for marginalized communities. DEI education is essential for preparing OTs to provide culturally responsive care to diverse client populations, which is a key element of quality healthcare.
Survey Results Comparison: How do students and faculty compare at TWU?
Building
on the broader need for DEI education in OT, two needs assessments were
performed to shed light on the current state of DEI education at TWU. The first
assessment was conducted by TWU Dallas’s Coalition of Occupational Therapy
Advocates for Diversity (COTAD) co-chairs with TWU OT students to determine
their thoughts on the incorporation of DEI in TWU’s OT curriculum.
Subsequently, I conducted the second needs assessment with the TWU OT faculty
to determine their insights on DEI usage in their teaching. The findings of
both show striking similarities that suggest a clear need for increased
attention to DEI in OT education. For example, both students and faculty
responded that the three most poorly addressed areas in the OT program were
gender and sexual diversity (42% and 64% respectively), immigration and refugee
experiences (40% and 64%), and racism (38% and 57%). Regarding topics to be
addressed more in the program, both students and faculty wanted cultural
influences on occupation to be covered in the curriculum (85% for both). The
majority of both groups surveyed in the needs assessment wanted bias and
privilege also covered. However, a majority of faculty also wanted to address
additional areas of advocacy (69%) and anti-racism & privilege (62%).
Gender identity and inclusive language were two additional significant areas of
interest to be noted.
Figure 1. Comparison of Faculty and Student DEI Curriculum Assessment.
The
first needs assessment conducted by COTAD used a pre-established survey with
differences in options compared to the second needs assessment I conducted, but
the results from both showed overlap with desired resources. When asked about
their preferences concerning methods of learning about DEI in OT, most students
chose in-class activities centered around conversations and discussions, with
an emphasis on cross-cultural communication (learning culturally appropriate
techniques of asking and responding to questions). 85% of faculty agreed. Yet,
the majority of faculty (92%) preferred DEI resources to be developed in the
form of case studies. 69% of faculty chose videos and journaling prompts. One
specified method of deliverable was evidence-based articles, specifically regarding
the efficacy of including DEI pedagogy at a societal level. One possible
explanation of this difference in preference is that both like classroom
materials to be interactive and engaging, but faculty must also balance this
with licensure preparation, curriculum requirements, evidence-based approaches,
and foundational knowledge as experienced educators. Below are my suggestions
of pedagogical resources based on the compiled data that may interest TWU OT
faculty and other clinical staff.
Figure 2. Comparison of Student and Faculty DEI Resources.
Case Studies
The first pedagogical resource to aid TWU faculty’s instruction would be case studies. Faculty can use case studies that incorporate DEI in their classroom to learn and teach how culture influences occupations. These studies could describe clinical scenarios with clients who identify as members of historically marginalized communities (e.g. LGBTQ+, Muslim, Black). Evidence-based articles on cultural influences are provided in this external document as a supplement for context in the case studies. According to Thistlewaithe et al. (2012), using this type of resource allows students to apply background knowledge, identify barriers and integrate clinical knowledge to create interventions and solutions for treatment, and gain knowledge of appropriate means for communicating with clients from the aforementioned communities. Case studies are effective pedagogical resources for students to practice clinical scenarios that may occur in real situations and prepare them to be more culturally responsive practitioners (Thistlewaithe et al. (2012)).
In-class Activities
For
a second solution, in-class activities that combine lecture material with
interactive DEI elements can be valuable education tools when presented as
hands-on cultural activities or via discussions centered around DEI topics with
evidence-based clinical application. Hands-on activities can include trying
food and participating in arts and crafts from less familiar cultures (Naber et al., 2021). Integrating such activities in an
OT lab class will give students a glimpse into specific client factors (values
and beliefs) and cultural occupations (personalized and meaningful engagement
in daily life events by a specific client) as defined by the Occupational Therapy
Practice Framework (2020). Client factors and occupations are
core tenets of OT practice; becoming familiar with diverse traits and
occupations will provide future practitioners more insight into the cultural
occupations that are important to their clients. Discussions, another suggested
in-class activity, can revolve around actionable ways of being anti-racist
practitioners, recognizing and addressing microaggressions in clinical
practice, and acknowledging and disrupting our own biases. This activity can be
semi-structured with open-ended prompts and moderated by the faculty member.
Through discussions, students can self-reflect, process, and learn from their
peers. It is critical, however, for faculty to create a safe environment prior
to starting these conversations in order for students to be honest and
vulnerable when speaking about difficult topics. For more information on
creating a safe community in the classroom, please peruse the previous CFE blog
posts, including:
- Spring Semester Resolution: Healthy Boundaries In and Out of the Classroom
- Living Group Work Contracts
- Beginning the First Day of the Semester Right
- Humanizing Your Course
Community-based Activities
Finally, community-based activities are events and programs that occur within the local community and aim to improve the quality of life for community members. These are valuable for budding practitioners to discover available resources in the area to which they can refer clients. There are many community organizations and services students may be unfamiliar with (e.g. The Resource Center, Northwest Community Center, Black Trans Advocacy Coalition) that support historically marginalized groups. For example, a potential community-based activity could entail students visiting a community site that has experienced injustices and writing a business plan to identify solutions. Another activity could involve students choosing from a prepared list of community organizations and researching further into ones that offer safe and reliable housing, work, and/or additional services for immigrants, refugees, and LGBTQ+ clients who may run into issues due to discrimination. A final activity could prompt students to attend a religious service they are unfamiliar with to become more informed about the traditions and customs associated with that religion. Faculty should provide alternative options for students who are unable or unwilling to attend a religious service; this may include reading about religious practices or engaging in discussions with individuals from that religious background.
Final Thoughts
The needs assessments’ results show some differences of opinion between TWU’s OT students and faculty on methods of learning about DEI in OT, but both tend to agree on which DEI topics should be covered more in the curriculum. Faculty prefer clinical evidence and resources that are easily digested and dispersed, and students want more experience with cross-cultural communication. The difference in preferences between faculty and students highlights the importance of considering different perspectives and approaches when designing pedagogical resources. Understanding this difference can help educators design resources that are more effective and engaging for students, while also meeting faculty standards and expectations. This may involve incorporating more experiential learning opportunities, providing access to resources in different formats, and emphasizing the importance of evidence-based practice and interpersonal skills in healthcare. Developing and providing pedagogical resources is one step in closing the gap on addressing the lack of diversity, equity, and inclusion in the OT curricula. These resources alone will not resolve all of OT’s DEI needs, and ongoing efforts and commitment to promoting DEI in OT education and practice are necessary. From there, faculty can implement these resources into their instruction to prepare students to be culturally aware practitioners.
Molly Song, CFE Blogpost Guest Author
TWU Occupational Therapy Doctoral Capstone Student
Co-mentored by Dr. Dayton Kinney,
Coordinator of Teaching, Learning, & Academic Excellence
References
Bolding, D. J., Rodriguez, V., Nguyen, H., & Drabble, L. A. (2020). Survey of occupational therapy students' attitudes, knowledge and preparedness for treating LGBT clients. Journal of Occupational Therapy Education, 4(2). https://doi.org/10.26681/jote.2020.040203
Brown, E. V., Muñoz, J. P., & Powell, J. M. (2011). Multicultural training in the United States: A survey of occupational therapy programs. Occupational Therapy In Health Care, 25(2-3), 178-193. https://doi.org/10.3109/07380577.2011.560240
Grenier, M., Zafran, H., & Roy, L. (2020). Current landscape of teaching diversity in occupational therapy education: A scoping review. The American Journal of Occupational Therapy, 74(6), 7406205100p1-7406205100p15. https://doi.org/10.5014/ajot.2020.044214
Matteliano, M. A., & Stone, J. H. (2014). Cultural competence education in university rehabilitation programs. Journal of Cultural Diversity, 21(3), 112–118. https://ezp.twu.edu/login?url=https://www.proquest.com/scholarly-journals/cultural-competence-education-university/docview/1560769187/se-2
Mitchell, T. (2021, May 25). Amid national reckoning, Americans divided on whether increased focus on race will lead to major policy change. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2020/10/06/amid-national-reckoning-americans-divided-on-whether-increased-focus-on-race-will-lead-to-major-policy-change/
Naber, A., Adamson, A., Berg-Poppe, P., Ikiugu, M., Tao, H., & Zimney, K. (2021). Using embedded encounters to promote cultural humility in occupational therapy and physical therapy education. Journal of Occupational Therapy Education, 5(1). https://doi.org/10.26681/jote.2021.050113
Occupational therapy practice framework: Domain and process—Fourth edition. (2020). The American Journal of Occupational Therapy, 74(Supplement_2), 7412410010p1-7412410010p87. https://doi.org/10.5014/ajot.2020.74s2001
Schaeffer, K. (2023, January 9). U.S. Congress continues to grow in racial, ethnic diversity. Pew Research Center. https://www.pewresearch.org/fact-tank/2023/01/09/u-s-congress-continues-to-grow-in-racial-ethnic-diversity/
Sterman, J., Njelesani, J., & Carr, S. (2022). Anti-racism and occupational therapy education: Beyond diversity and inclusion. Journal of Occupational Therapy Education, 6(1). https://doi.org/10.26681/jote.2022.060103
Thistlethwaite, J. E., Davies, D., Ekeocha, S., Kidd, J. M., MacDougall, C., Matthews, P., Purkis, J., & Clay, D. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME guide No. 23. Medical Teacher, 34(6), e421-e444. https://doi.org/10.3109/0142159x.2012.680939
U.S. Census Bureau. (2021). QuickFacts. U.S. Department of Commerce. Retrieved February 21, 2023, from https://www.census.gov/quickfacts/fact/table/US/PST045221#
