Student level II fieldwork failure: strategies for intervention.

OBJECTIVE This report describes how common student communicative and behavioral characteristics that appear to predict the existence of potential problems during Level II fieldwork were identified in order to develop and implement preventative interventions during the academic curriculum at New York University (NYU). RECORD REVIEW: A record review of NYU professional-level occupational therapy students from 1986 to 1995 was completed to identify common factors among students who performed well academically but failed clinical fieldwork. Eight communicative and behavioral characteristics were identified: (a) rigidity of thinking, (b) discomfort with the ambiguity that accompanies clinical reasoning, (c) lack of psychological insight, (d) difficulty interpreting feedback, (e) externalization of responsibility, (f) difficulty learning from mistakes, (g) discomfort with the physical handling of patients, and (h) dependence on external measures for self-esteem. INTERVENTION On the basis of the identified characteristics, five intervention strategies were adopted: (a) academic seminars that address professional behavior and interpersonal skills, (b) faculty feedback to students regarding problematic behaviors, (c) clinician and senior student counseling with identified students, (d) student remediation programs consisting of community service, and (e) student learning contracts based on specific behavioral objectives. These strategies were administered before Level II fieldwork to 10 students in the 1996 class who exhibited the characteristics indicative of potential fieldwork failure. OUTCOME Of the 10 students in the 1996 class, 7 passed fieldwork without further difficulty, two failed fieldwork midterm assessments but went on to achieve passing final evaluations, and one failed the final fieldwork assessment but passed an additional third fieldwork experience. The class of 1996, which was the first to receive formal intervention designed to decrease fieldwork failure, demonstrated lower fieldwork failure rates than did all other classes in the past 10 years.