Research is not core to Occupational Therapy (OT) practice ..
… and is therefore not part of an OT’s professional identity.
This Blog was originally written for the research debate at the Royal College of Occupational Therapy National Conference 2019. Links to the YouTube video can be found below.
I’m going to give three compelling arguments for this motion, three good reasons why research is core to the profession and therefore part of our professional identity. But before that I am going to share with you three reasons about why I believe research needs to be core to Occupational Therapy practice and is therefore integral to our professional identity. A dictionary definition of ‘core’ is ‘heart of a fruit’. Just as the core is central to an apple’s existence, research is central to the existence of Occupational Therapy practice. I believe that research yields the fruits that will nourish and sustain the life of our profession into the 21st century and beyond.
Research is important to me for several reasons, firstly I have witnessed how being part of a research study can save and transform lives. My Uncle was diagnosed with bowel cancer last year, he asked me should I participate in 2 studies that were offered, I encourage him too and this saved his life. He would not be alive today if it wasn’t for the opportunity to join a study and receive investigations that were not part of current service delivery. Research enables the trial of new treatments and interventions, offering patients new choices and new innovations that can transform and save lives.
Secondly as a manager and clinical leader in the NHS the clinical and cost effectiveness of my services are paramount. My first experience of research was when I become a primary investigator on a study investigating the efficacy of using Nintendo Wii to improve affected arm function after stroke. I was keen to utilize technology in practice.
I made some clinical assumptions about this intervention but it wasn’t until I took part in the study that my eyes were truly opened to the benefits, challenges and the perspective of the patient and the carer. This study and its outcomes fundamentally changed the way I thought about the use of technology in rehabilitation, changed my practice and importantly gave clinicians and patient’s evidenced based choices for upper limb rehabilitation.
Thirdly I spent a year developing a research impact tool for the NHS with CLAHRC YH; we curated 23 case studies using the tool from nursing and allied health professions exploring the impact of clinical research in the NHS. http://clahrc-yh.nihr.ac.uk/victorimpact
I have listened with fascination to patients, carers, clinicians and researchers about the impact that research has made, but not just the obvious outputs from research, I’m talking about the stuff that’s usually invisible, the difference it can make to people, skills, service improvement, teams, recruitment and retention.
Research is a core ingredient of our professional life and when it’s missing it’s like serving up a Sunday roast without Yorkshire puddings in our house, it’s just plain wrong, it’s an essential component part. I believe that research needs to be hardwired into our clinical roles so that it’s integral and core to our everyday practice.
My first argument is that research is core to professional identify because we are a regulated profession and evidenced based practice is a requirement of the HCPC registration.
12.1. and 12.2 of HPCP standards of proficiency for Occupational Therapy* require OTs to assure their quality of practice. As registered professionals we invest in ourselves and take ownership of our professional destiny and this is what defines us as practitioners.
https://www.hcpc-uk.org/standards/standards-of-proficiency/occupational-therapists/
The fourth pillar of the RCOT Career Development Frameworkis dedicated to evidence, research and development. The framework describes research as core to career development; we are challenged to positively question our own practice and the practice of others to create opportunities to generate new knowledge.
https://www.rcot.co.uk/practice-resources/learning-zone/career-development-framework/
Engagement in evidenced based practice contributes to defining our professional identity through structured reflection, learning and research.
Using research evidence in our practice ensures treatment techniques are effective and that we are delivering clinically and cost-effective services. It helps us keep up to date and enables us to help patients make informed choices about their treatments.
In my current role as a programme manager and workforce lead, I have gained insights into working at system level. I have observed the challenges of commissioning services on a backdrop of constrained resources, scrutiny of quality, cost effectiveness. In austere times services are rationed and commissioning is determined by evidence, therefore we need to demonstrate that we are making best use of our resources and are evidenced in our practice.
Professions must withstand critical analysis from many sources and OTs must be able to clearly describe their unique selling point for managers and commissioners, demonstrate the evidence base and where we can add value. So here is the important bit, this is great news for Occupational Therapy as we are all about outcomes that matter to the person- but evidencing this contribution is vital, we need to be evidenced based and outcome focused in our practice to demonstrate that commissioning OT services a ‘no brainer’.
The RCOT strategic intentions have a burning ambition to position the profession for 21st century. To do this we need to respond to the changing landscapes, in a state of readiness for the opportunities which lay ahead but I propose we cannot fulfil this aspiration without the essential core ingredients of research and its connection to the very heart of what we do.
https://www.rcot.co.uk/about-us/governance/strategic-intentions
My second argument is that we have the power to influence and shape our own research identity and therefore have a choice about how we are seeing ourselves and how we are portrayed as a profession.
Professional identity is created through our beliefs, attitudes, values and motives and experiences, and this is how we define ourselves in professional life (1).
We all have unique perceptions of our own experiences that contribute to how we feel about our identities. Kielhofner (2) said that ‘personal meaning is reflected by one’s values, things of importance to a person’. If this is the case, we need to ask ourselves, is research important to me?
I propose whether research is part of your identity or not is your choice.
So, let’s explore our professional identity in relation to research. We identify with those we respect and admire with those we feel infinity to; our identities shift and develop over time but gradually strengthen as we grow in confidence.
Professional identity is not static it’s a fluid living concept strongly influenced by how we see ourselves, how we perceive others and how we are seen by society at large (3).
If this is the case, we can view identity as something we can adapt and change.
I would like you to take a moment to visualise your professional identity as an Occupational Therapist …now image there is a barcode on the back of your neck, 'beeb', what would it read about you and your professional identity?
Now I would like you to consider how your professional identify has it been shaped by your role models and work experiences. Across your career has your identity changed? Consider at which point you had the strongest professional identity?
Was it when you were in university or was it when you first graduated and felt you could change the world? Is it stronger now than it was when you first qualified? Or do you at times feel you have lost your focus or identity as an OT?
Now think about your identity in relation to research. Are you a student or newly qualified, just had your first taste of research and are hungry for more, or are you thinking never again research is not for me? Are you an experienced clinician a consumer of research who is evidence based in practice, do you think research is something other people do, or are you’re an academic with research hardwired into your DNA?
So you may be sitting there thinking research is something that is more relevant to other people and it’s not part of your professional identity.
That is what I used to think, but through exposure to new experiences and making conscious decisions to engage with research on several levels my ‘mind set’ changed. Therefore, exposure to research related activities can engage growth of mind set, prompt the evolution of our thoughts and influence your identity.
According to the author ELJames there are ‘50 shades of grey’, I believe there are 50 shades of research engagement. So, what’s your involvement in the research continuum? Are you a research consumer, participator, do you read research literate, assess, evaluate and translate findings into practice? Are you involved in research design, telling a patient about a study or connecting them with research?
On the 50 shades spectrum research could be in your foreground or rear-view mirror depending on the situation, context and demands of your role. You may think that research is in your rear-view mirror, but it is still core to our practice.
If we don’t engage with the research spectrum we could suffer from a lack of professional identity, among OTs this can lead to a lack of ability to think strategically and be over influenced by other professionals, leading to feeling professionally undervalued (4). So, this is a call to action, take responsibility for how you see yourself in relation to research and influence how others see you. Research is core to your practice and part of your professional identity.
My third argument is that research is a core part of our history, our today and our future survival.
On my bookcase at home I have volume 1&2 of Occupation for Health by Ann Wilcock a history of occupational therapy from its earliest times (5) (6). Wilcock explores the origins of occupation and health traced back to biblical times. In volume two chapter six tells us that “the first documentation of research and OT was noted by Homersley in the 1944’s who considered that the UK was a long way behind American colleagues in both original research and publications and called for the initiation of a scheme of research (6).
Homersley’s wrote ‘what we need, I feel is a more scientific and critical attitude towards our work if we are not to sip back for 20 years and find ourselves damaged once more with the ‘arty-crafty’ label (6). In response to this OT council of 1946 raised £69.00 to create a fellowship fund to allow experienced OTs to give attention to research and in the 1950’s the first research papers were published in Occupational Therapy Journals.
In 1964 at the American Congress Yerxa (7) defined research as a purposeful, problem-solving, planned observation- are these not features of core OT practice? Research is an occupation- a systematic inquiry, finding out and generating new knowledge. It’s an interplay between curiosity, creativity, critical thinking, abilities and knowledge.
Flash forward to today there are NIHR career pathway ways for clinical academic careers and a multitude of strategies, guidelines and policies with a mandate to use an create research knowledge in clinical practice.
Research can help us prove that we are an influential force and are a valuable workforce for the future. OTs have a critical role in promoting and supporting the implementation of research findings and developing a research culture that values and supports research activity, as an integral part of the profession. It’s no longer good enough to say something works we need the evidence.
So in summary…
Being a big Harry Potter fan I love the words spoken by Sirius Black (Order of the Phoenix) ‘the world isn’t split into good people and death eaters, we’ve all got both light and dark inside us, what matters most is the part we choose to act on and that’s who we really are’.
So through the ‘Sirius Black’ lens I propose that OTs are not split into ‘those that do research and those that don’t’, we’ve all got the potential to engage in the many shades of research and have research as core to our practice and part of our professional identity. It’s what we choose to do about it and how we engage with research that will enable us to thrive and survive, shaping an evolving or attitudes, beliefs, values and motives for a brighter future.
You can watch the debate and hear the fabulous debating team below.
1. Schien E. Career Dynamics: Matching Individual and Qrganizational Needs [Internet]. Lebanon, Indiana, U.s.a.: Reading, MA: Addison-Wesley; 1978. Available from: https://www.biblio.com/9780201068344
2. Kielhofner G, Posatery Burke J. A Model of Human Occupation, Part 1. Conceptual Framework work and Content. Am J Occup Ther. 1980;34(9):572–81.
3. Beijaard, D. Meijer, P. & Verloop N. Reconsidering research on teachers’ professional identity. Teaching and Teacher Education. Teach Teach Educ [Internet]. 2004;20:107–28. Available from: http://hdl.handle.net/1887/11190
4. Turner A, Knight J. A debate on the professional identity of occupational therapists. Br J Occup Ther. 2015;78(11):664–73.
5. Allart Wilcock A. A Journey from Self Health to Prescription Volume 1. Published 2001 by College Of Occupational Therapists, editor. Clephane Hume; 2001. 583 p.
6. Allart Wilcock A. A Journey from Prescription to Self Health Volume 2. London; England: Published 2002 by College Of Occupational Therapists; 2002. 590 p.
7. Yerxa E. Habits in Contect: A Synthesis, With Implications for Research in Occupational Science. Occup Ther J Res [Internet]. 2002;22:104–10. Available from: otj.sagepub.com
*(HPCP 12.1 be able to engage in evidence-based practice, evaluate practice systematically and participate in audit procedures 12.2 be able to gather information, including qualitative and quantitative data, that helps to evaluate the responses of service users to their care).