Occupational Therapy Clinical Experiences

Occupational therapy is one of many healthcare professions that require clinical exposure before entering the field. Occupational therapy clinical opportunities are called fieldwork rotations, clinical rotations, or clinical experiences depending on the program. These experiences simulate the work day and job duties of an occupational therapist. 

Level 1 Fieldwork

Observational fieldwork opportunities, also called Level 1 fieldwork experiences, start early in occupational therapy programs. Students shadow a currently working occupational therapist in a hospital, nursing facility, school system, outpatient clinic, or other facility. This allows an occupational therapy student to see the realities of a day in the life of an occupational therapist.

These experiences frequently focus on student observation of occupational therapy practice in traditional and common settings. Some required observational fieldwork experiences take place in settings which utilize an occupational therapist’s skill set in a different way. For example, a student may observe an occupational therapist assisting a senior center or community center in developing programs for their members.

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Each occupational therapy program typically consists of about eight Level 1 fieldwork opportunities, or about two Level 1 placements for both the fall and spring semesters. These Level 1 opportunities often take place for several hours once per week during the semester alongside standard academic courses. Academic fieldwork coordinators, or AFCs, are professors who place students in each of these opportunities.

While the goal is to take into consideration student input and preference for settings, this is not always possible. Certain geographic areas limit the ability of a fieldwork coordinator to place students in a variety of settings. Fieldwork opportunities also depend on whether available facilities have occupational therapists who are willing to supervise students. While there are no applications needed for these fieldworks, students interview at most facilities before starting work.

Level 2 Fieldwork

Once students are in the graduate portion of their occupational therapy programs and enrolled in Master’s-level courses, their fieldwork opportunities progress to required Level 2 experiences. These Level 2 fieldwork opportunities consist of more hands-on work under the supervision of a practicing occupational therapist. Level 2 fieldwork opportunities mimic the exact hours of a currently-practicing occupational therapist. This gives students an idea of the roles and tasks they will need to complete for a standard work week. Each Level 2 fieldwork typically lasts for 12 weeks during which the student will focus solely on the fieldwork and take no other classes.

Student job duties include treating and evaluating patients, billing for services, and completing therapy documentation. The level of supervision provided by the occupational therapy supervisor varies depending on the site and the supervisor’s teaching style. For example, inpatient mental health facilities which have locked wards may require a supervisor to be present during any and all student-patient interactions for safety reasons. Less structured settings such as outpatient clinics may allow for a higher degree of freedom.

Supervisors provide close supervision, including several hours of mentoring, discussion, and orientation per day at the start of the fieldwork opportunity. As the fieldwork opportunity progresses, supervisor time drops to several hours of mentoring per week. Level 2 fieldworks also require interviews, but no application process.

Post Graduate Residencies

Learning opportunities do not stop after a therapist graduates. Practicing occupational therapists can enroll in residencies to further their knowledge in a particular subject area. The American Occupational Therapy Association has a list of approved residencies in the areas of physical rehabilitation, acute and critical care, hand therapy, mental health, dysphagia, burns, pediatrics, geriatrics, neurology, and assistive technology. These programs often take place at prestigious facilities across the country.

The application process for residencies varies depending on the facility. Most applications include professional references, transcripts, a resume, a cover letter, and a personal statement expressing why you are interested in the position. Many residencies also require applicants to have one year or more of demonstrated experience in the clinical area of choice. Most residencies are nine months to one year in length with set application deadlines to accommodate for fixed start dates. 

These residency opportunities allow therapists to gain specialized experience from therapists who are experts in their fields. While these residencies often include components of evaluating and treating patients according to the specific practice setting, treatment is not the sole focus of the program. Since these opportunities are targeted to practicing therapists rather than students, basics of therapy treatment are not the focus. Rather, these programs can include completion of research projects, administrative tasks for experience, case studies, and community learning experiences to further the expertise provided to the therapist who is enrolled.

Opportunities such as observation, hands-on treatment, and learning projects allow occupational therapists with a range of experience to gain more knowledge in areas of their choice. These experiences not only increase the range of a therapist’s treatment abilities, but they also allow for improved clinical reasoning skills and overall judgment. Most of an occupational therapist’s job duties require a wide lens to provide well-rounded and client-centered treatments. This type of knowledge and judgment only develops from a well-rounded set of experiences and learning over time. Thankfully, occupational therapy programs have a wide range of opportunities designed to provide this experience to all therapists.