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BACKGROUND Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, i.e., within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. OBJECTIVE The overall aim of this study is to gain a better understanding of the complex dynamic process leading to clinical professionals’ and clinical managers’ fear of reprisal in their change agent actions and senior administrators’ and senior managers’ determination of wrongdoing. METHODS A three-part sequential mixed-method design will include: 1) online survey; 2) qualitative grounded theory design; and 3) legal and ethical analysis. RESULTS This ongoing study began in June 2022 and is scheduled for completion by March 2027. CONCLUSIONS Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities as an agent serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. CLINICALTRIAL N/A

Background: Acting as a change agent (CA) is a key role for Health and Social Services (HSS) professionals. It involves working collaboratively with actors across and outside the HSS system and influencing decision-makers. However, this role requires specific skills that HSS professionals generally feel that they have not mastered. The overarching goal of this research partnership is to explore the development of CA skills by HSS professionals using a customized training program. Methods/Design: Through a research partnership, 128 HSS professionals will receive 7 hours of training using a professional co-development approach and a checklist. The immediate and medium-term effects of the training on their skills development will be evaluated with a self-administered questionnaire before and immediately following the training and again nine months later. The data will be analyzed using descriptive and inferential statistics. Discussion: This study will shed light on the effects of a customized training program on CA skills development. It will also have three main benefits: (1) development of an easy-to-reuse CA training program and checklist; (2) partner’s ownership of these products through close involvement; and (3) development of a sustainable partnership between a team of researchers and a recognized organization with an extensive HSS network.

Background: Implementing elder-dedicated local health and social services (LHSS) is primary for older Canadian adults to age in place. However, there is currently no synthesis of the factors (barriers and facilitators) involved in LHSS implementation. Objective: This study aimed to synthesize current knowledge about the institutional factors involved in elder-dedicated LHSS implementation by describing them and their influence. Methods: A scoping review was conducted using eight databases and the grey literature. Data were analyzed thematically. Results: A total of 23 documents led to the identification of 15 inter-influencing factors (12 barriers and 11 facilitators). Indeed, 20 connections were noted among factors, mostly among barriers. Discussion and implication: Although some barriers and facilitators also affect the implementation of services dedicated to the general population in Canada, the interplay between agism and power issues needs to be taken into consideration for a successful elder-dedicated LHSS implementation.

La reddition de compte et l’optimisation de la performance visent à améliorer la performance des services de soutien à domicile (SSAD) mais ne semblent pas avoir les effets escomptés. Le manque de latitude décisionnelle des professionnels et, conséquemment, leur réactivité insuffisante seraient en cause. Cette réactivité relève pourtant du rôle d’agent de changement, encore peu investi. Cet article poursuit trois objectifs : 1) Synthétiser les connaissances sur le rôle de la reddition de compte et de l’optimisation de la performance dans la pratique des professionnels des SSAD ; 2) Décrire le rôle d’agent de changement ; et 3) Explorer son enseignement.

Background.When acting effectively in their social change agent (SCA) role, occupational therapists can impact population health and occupational justice. However, empirical evidence of the influence of personal and environmental factors on their ability to act as SCAs is scarce.Purpose.To explore personal and environmental factors that influence the ability of occupational therapists to act as effective SCAs.Method.We conducted a descriptive interpretive qualitative study with 18 Québec occupational therapists recognized as successful SCAs. We collected data through semi-structured interviews with three focus groups and analyzed them thematically using a lexicon.Findings.We identified nine cross-cutting personal factors, including discovery, effective communication, and planning, that enable occupational therapists to act as successful SCAs. Six thematic groups of environmental factors facilitated or hindered their actions.Implications.To act effectively as SCAs, occupational therapists need to consider personal and environmental factors involved in their change project.

Background. Change agents’ actions have been studied mainly from a theoretical perspective. Purpose. This study aimed to empirically identify occupational therapists’ actual change agent actions. Method. As part of a research partnership with the Canadian Association of Occupational Therapists-Québec chapter, we conducted this cross-sectional pilot study using an online survey. Findings. The change agent practices of our 103 participants involve many types of actions but show underinvestment in mass communication. Mass communication actions are more frequent when participants have greater experience, additional academic degrees, and training in change agency. Also, occupational therapists with additional academic degrees and change agency training tend to use a wider variety of actions. Finally, our participants’ actions principally target actors in the clinical context, rarely political actors. Implications. Our results suggest that occupational therapists can and will invest in the full range of change agent actions provided they can acquire the necessary knowledge and skills.

Background. There is an emerging evidence base about the scope of occupational therapy in palliative and end-of-life care, but little is known about this practice in Québec or barriers impeding it. Purpose. To describe Québec occupational therapists’ practice in palliative and end-of-life care and barriers they encounter. Method. Using the Québec regulatory board members list, we invited occupational therapists working in palliative and end-of-life care to answer an online survey comprising 24 closed- and 5 open-ended questions. We analyzed data using descriptive statistics and content analysis. Findings. The 67 survey participants mainly optimized comfort and safety in meaningful occupations such as mobility, transfers, and hygiene. Barriers to their practice included organizational obstacles and unfamiliarity with their role. Implications. Findings highlight the need to improve education and awareness among occupational therapists and other healthcare professionals about the scope of what occupational therapists can do in palliative and end-of-life care.

Clinical reasoning (CR) is the cognitive process that therapists use to plan, direct, perform and reflect on client care. Linked to intervention efficiency and quality, CR is a core competency that occurs within an institutional context (legal, regulatory, administrative and organisational elements). Because this context can shape how community therapists think about their clients' care, its involvement in their CR could have a major impact on the interventions delivered. However, little is known about this involvement. Our study thus aimed to describe the elements of the institutional context involved in community therapists' CR. From March 2012 to June 2014, we conducted an institutional ethnography (IE) inquiry in three Health and Social Services Centres in Québec (Canada). We observed participants and conducted semi-structured interviews with 10 occupational therapists. We also interviewed 12 secondary key informants (colleagues and managers) and collected administrative documents (n = 50). We analysed data using the IE process. Of the 13 elements of the institutional context identified, we found that four are almost constantly involved in participants' CR. These four elements, that is, institutional procedures, organisation's basket of services, occupational therapists' mandate and wait times for their services, restrictively shape CR. Specifically, occupational therapists restrict their representation of the client's situation and exploration of potential solutions to what is possible within the bounds of these four elements. In light of such restrictions on the way they think about their clients' care, therapists should pay close attention to the elements of their own institutional context and how they are involved in their CR. Because of its potentially important impact on the future of professions (e.g. further restrictions on professionals' role, reduced contribution to population health and well-being), this involvement of the institutional context in CR concerns all professionals, be they clinicians, educators, researchers or regulatory college officers.

Background. Occupational therapists who provide community-based services are well positioned to foster older adults’ social participation. However, community occupational therapists rarely address social participation and require support to change their practice. Purpose. This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults’ social participation and (b) identifying factors that could affect their integration. Method. A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. Findings. A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. Implications. These results point to innovative ways to foster older adults’ social participation and identify potential enablers and barriers affecting their integration.

Background As social change agents (SCAs), occupational therapists (OTs) are expected to defend the rights of their clients, advocate for and with them, and try to influence organizational and political decision-makers. However, OTs do not generally feel equipped to take effective action. The overall goal of this research partnership is to support practising OTs in acquiring the knowledge and skills required to act as SCAs through a specific SCA training program and a toolkit that summarizes the key training points. Methods The study will include three iterative phases (conceptualization, implementation and evaluation) and use a participatory process. The design of the training program and toolkit will draw on the expertise of the researchers (theoretical knowledge), a professional provincial partner and study participants (experiential knowledge). To evaluate the training program and toolkit, a self-administered evaluation questionnaire, facilitator observation grid and semi-structured guide designed to facilitate focus group discussions will be used. The quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The results of the initial implementation and evaluation phases will inform improvement of the training program and toolkit before starting the cycle with the following groups. Discussion In addition to training about 100 OTs, this study will produce three main benefits: 1) development of two products, namely the SCA training program and toolkit, that are easy to reuse and potentially transferable to other professionals; 2) ownership of these products by the partner through its close involvement in all stages of the study; and 3) development of a sustainable partnership between a team of researchers and a recognized organization with networks across Canada and internationally. These three spin-offs will provide a solid basis for an increasing number of permanent implementation initiatives, in Québec and elsewhere in Canada, not just in occupational therapy but also in other professions.

Evidence-based practice integrates and supports the best interventions in clinical practice. However, a gap of about ten years may elapse between the production of evidence and integration of best practices in clinical settings. Some technologies, such as podcasting, have become increasingly popular and are emerging as an innovative teaching modality that can support knowledge acquisition and integration. This scoping study gathered and synthesized the information in the literature regarding the use of podcasts by occupational therapy clinicians and students as a means for teaching and learning evidence-based knowledge. A scoping study approach was used following the five stages defined by Arksey and O'Malley. In four databases and using 40 keywords, two team members selected and cross-checked articles. Two team members also extracted data and analyzed them in the form of descriptive statistics and salience (recurrence and importance). Of the 46 articles selected, seven broad categories of 20 important themes related to the use of podcasting were identified: facilitators and obstacles to podcast use, advantages and disadvantages of podcasts, effects of podcasts, potential utility of podcasts, and elements to consider for podcast creation. Podcasting is an innovative and appropriate modality for the retention of knowledge and the optimization of practical skills. It differs from traditional methods in its ease of access and portability. Many positive effects have been associated with its use. However, podcasts should not replace class attendance or other active learning opportunities.

IntroductionTo promote active and healthy ageing, it is important to foster social participation. Although well positioned to do so, few community occupational therapists intervene to address socia...

Objectif : L’implication des mecanismes de reddition de compte et d’optimisation de la performance dans le raisonnement clinique (RC) menant au choix des interventions au soutien a domicile (SAD) est peu connue. Cette etude visait a explorer cette implication dans le RC des ergotherapeutes en SAD.Methodes : Une ethnographie institutionnelle (EI) a ete utilisee aupres de dix ergotherapeutes recrutes dans trois programmes de SAD quebecois. Des observations (n = 41 jours) et des entretiens semi-diriges (n = 216 entretiens) ont ete realises. Douze informateurs-cles secondaires (collegues, gestionnaires) ont egalement ete rencontres (n = 22 entretiens) et des documents administratifs (n = 50), recueillis. Les donnees ont ete analysees a l’aide du processus de l’EI.Resultats : Le RC des ergotherapeutes inclut une preoccupation constante quant a leur productivite qui module leurs interventions aupres des patients. Les ergotherapeutes restreignent le temps et le suivi alloues a chaque patient. Leurs interventions se limitent au motif de reference, generalement l’autonomie dans les soins personnels, sauf si la securite du patient est menacee. La mesure du travail utilisee dans la reddition de compte et l’optimisation devient l’etalon pour evaluer la legitimite des activites et genere des comportements deviants afin de rencontrer les objectifs de performance.Conclusion : La reddition de compte et l’optimisation risquent de compromettre la qualite des services rendus, l’etendue des services offerts aux patients, incluant les activites de prevention et de promotion de la sante, et, consequemment, l’atteinte des objectifs du systeme de sante.

In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented.This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles.A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec.In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties.Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.L’évaluation du client est primordiale dans la pratique de l’ergothérapie, notamment pour établir les priorités de traitement et pour vérifier l’efficacité des interventions. Les pratiques évaluatives des ergothérapeutes sont cependant peu documentées.Dresser un portrait des pratiques évaluatives des ergothérapeutes du Québec selon les dimensions personne-environnement-occupation et les clientèles.Une enquête transversale a été réalisée à l’aide d’un sondage en ligne envoyé aux ergothérapeutes du Québec.En pédiatrie, les ergothérapeutes utilisent majoritairement des outils standardisés des aptitudes physiques et neurologiques. L’évaluation d’adultes cible principalement les aptitudes physiques et la productivité. Auprès des aînés, l’évaluation repose surtout sur les aspects fonctionnels, particulièrement les aptitudes physiques, les soins personnels et la sécurité à domicile, et sur le dépistage des difficultés cognitives.L’évaluation ergothérapique serait généralement axée sur les aptitudes physiques. Pour assurer une approche holistique, l’occupation et l’environnement devraient être davantage considérés dans l’évaluation.

Background: To increase homecare efficiency, the Ministry of Health and Social Services in Quebec, Canada, encourages standardization of practices, including those of community occupational therapists (COTs). The impact of standardization is not known and might reduce client-centeredness. Aim/objectives. To explore the content and use of a referral form to standardize COTs’ practice. Material/methods. An institutional ethnography inquiry was conducted through observations of work and interviews with 10 COTs working in three homecare programs. Secondary informants were also interviewed and documents collected. Data were analyzed using institutional ethnography procedures. Findings. The referral form, completed by the COTs’ colleagues, includes categories primarily related to safety or autonomy in personal care and mobility. The form organizes COTs’ work, including information collection and interactions with clients and caregivers. Seen as consultants, COTs assess needs and make recommendations to keep clients at home safely for as long as possible, an important element of the homecare discourse. Conclusion/significance. The impact on COTs’ potential to be truly client-centered revealed by these findings merits serious consideration by other health professionals. Concerted efforts by professionals to question and act upon contextual barriers to client-centeredness are needed.

Background/aim Increasingly, health-care systems should promote seniors’ health and prevent disability. As they enable engagement in meaningful activities within the individuals’ living environment, community occupational therapists have great potential to contribute to health promotion and prevention. Despite this potential, little is known about current health promotion and prevention activities in occupational therapy community practice. This study thus aimed to: (1) identify health promotion and prevention interventions used with seniors having disabilities, and (2) explore barriers to integrating such interventions into practice. Methods Secondary data analysis of a qualitative study was carried out using thematic saliency analysis. Eleven community occupational therapists working with seniors having disabilities were recruited in six community health settings in Quebec, Canada. Observations of 12 home visits, followed by 12 semi-structured interviews, were conducted with occupational therapists. Results Most interventions involved optimising independence in personal care and mobility. Explicit health promotion interventions were limited and included enabling healthy lifestyles by increasing health literacy and empowerment. Meaningful activities (leisure, community participation) were not targeted. Barriers to integrating health promotion into practice were clients’ complex health conditions and limited openness to change combined with organisational and professional obstacles, such as a misunderstanding of occupational therapists’ role in health promotion. Conclusions Health promotion and prevention interventions are not intentionally integrated into community occupational therapy practice with seniors having disabilities. As a result, seniors’ needs to engage in meaningful activities might remain unmet. Overcoming barriers to integrating health promotion and prevention in practice could help improve population health and wellbeing.

Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best—evidence-informed—policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze—quantitatively—health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network’s “absorptive capacity” regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. Methods: The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network’s and subnetwork’s effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Discussion: Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice on how to ensure evidence plays a more prominent role in public policies.

The restricted range of OT interventions is incompatible with their holistic and patient-centred profession. Accountability and optimization may compromise the quality of their services, the scope of services offered, including prevention and health promotion activities, and, consequently, the achievement of the healthcare system objectives./ce:para.

Description.L’evaluation du client est primordiale dans la pratique de l’ergotherapie, notamment pour etablir les priorites de traitement et pour verifier l’efficacite des interventions. Les pratiq...

La science ayant notamment pour but de contribuer à l’amélioration des conditions de vie et au mieux-être de la population, les chercheurs ont à produire et à partager des connaissances. Or, pour ce faire, l’utilisation de certaines stratégies potentiellement plus efficaces soulève des questionnements éthiques. Le présent article explore sommairement ces questionnements en s’intéressant à la dualité relative au format du message et au rôle social du chercheur., Because science aims to contribute to the improvement of living conditions and the well-being of the population, researchers have to produce and share knowledge. However, the use of certain potentially more effective strategies raises ethical questions. This article briefly explores these questions by focusing on the duality of the message format and the social role of the researcher., Essai / Essay

Introduction: Community occupational therapists frequently teach transfer skills to older adults. The teaching strategies used should be documented because they can affect the outcomes of interventions. Objective: The objective of the study was to identify the strategies used by community occupational therapists when teaching transfer skills to older adults. Method: Eleven community occupational therapists were recruited from six health and social services centres in Québec, Canada. Data were collected through observations of transfer interventions (n = 31), followed by in-depth interviews (n = 12). Data were analysed using descriptive statistics and grounded theory methods. Findings: Strategies consisted of nine methods, eight tools and nine intensity adjustments. The methods were explaining, demonstrating, having the client try, giving feedback on performance, involving the client, seeking and obtaining client's feedback, questioning, and involving a teaching assistant. Tools varied according to the teaching method. These tools were gestures, equipment, visual aids, written, verbal and somatosensory instructions, assistant as client and occupational therapist as client. Finally, intensity adjustments were related to the scope, directedness, duration, frequency and pace of teaching. Conclusion: A range of teaching strategies used by community occupational therapists were identified. Three methods, five tools and nine intensity adjustments were identified for the first time.

This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) "health literacy" with (ii) "rehabilitation", "occupational therapy", or "health promotion". Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community-dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.

Background Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. Methods A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. Results Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. Conclusions This study highlights the complexity of older adults’ participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults’ health and well-being. Discrepancies in the various actors’ perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

La schématisation vise à soutenir une construction active des connaissances chez l'étudiant. Pour ce faire, la rétroaction de l'enseignant est essentielle. Or, peu d'outils sont offerts pour soutenir une rétroaction véritablement centrée sur l'étudiant. Cet article offre une analyse descriptive de l’utilité perçue, par l’enseignant, d’un outil encadrant la rétroaction lors de la schématisation par leurs étudiants. Le dispositif pédagogique a été introduit auprès de 99 étudiants dans un cours de première année universitaire en réadaptation. L’outil comportait deux questions de réflexion à compléter par l’étudiant et à remettre à son tuteur avec son schéma d’un problème proposé lors de séance d’apprentissage par problème. Les tuteurs (n = 11) perçoivent clairement l’outil de réflexion comme étant utile pour faciliter leurs rétroactions écrite et verbale aux étudiants. Spécifiquement, l’outil fournit un cadre structuré à la rétroaction et favorise le passage d’une posture centrée sur le contenu par les tuteurs à une posture centrée sur l’étudiant et sa construction de connaissances. De plus, l’utilisation du dispositif pédagogique n’accroît pas le temps alloué à la rétroaction. Producing conceptual maps is intended to support an active construction of knowledge by the student. To do so, feedback from the teacher is essential. However, few specific tools are available to support a truly student-centered feedback in conceptual mapping. This article provides a descriptive analysis of the perceived usefulness, from teachers’ perspective, of a short reflexive tool to optimized feedback to students. The reflexive tool was used with 99 first-year rehabilitation students. The tool consisted of two questions that each student had to complete and give to his/her tutor with the conceptual map produced following a problem-based session. Tutors (n = 11) clearly perceive the tool as useful in supporting written and verbal feedback to students regarding conceptual mapping. Specifically, the reflection tool gives structure to feedback, allows to focus on knowledge building and enables student-centered feedback instead of a content-centered one. In addition, the use of the reflexive tool did not increase time spent on feedback.

This chapter provides a description of occupational therapists’ clinical reasoning. First, we present the clinical reasoning process integrative framework, including its internal and external factors of influence. Then, because of its core importance for effective practice, we discuss ways to learn about and improve clinical reasoning. Specifically, we propose a procedure inspired by Kolb’s experiential learning model and Vermersch’s explicitation technique to explicate and reflect upon one’s clinical reasoning process. This reflection reinforces one’s knowledge base, fosters expertise development, and optimizes clinical reasoning.

Accessibility of health care services is a major concern in many countries. This paper examines the impact of limited access to occupational therapy community services on the right to services, distributive justice (resource distribution based on social solidarity), and service quality. Legal documents and relevant scientific papers were analyzed from three standpoints: legal, ethical, and clinical. Random use of criteria to prioritize requests, partial response to complex needs, task delegation, and long waiting times, all affect distributive justice and compromise the right to and quality of services. Various alternatives are suggested to ensure a balance between the distribution and quality of occupational therapy services.