Success of non-traditional students in an undergraduate occupational therapy programme

Success of non-traditional studentsin an undergraduate occupationaltherapy programme*

NEIL WHEELER Occupational Therapy, Oxford Brookes University, Oxford

ABSTRACT: An exit survey designed to examine the experiences of occupationaltherapy undergraduates was administered to 365 students in a four-year honours pro-gramme. The survey had a response rate of 51% (186). The survey was informedand supplemented by focus groups with international students and computer-mediatedconferencing with community leaders from relevant ethnic minorities. Results showedthat older students and those with non-traditional entry qualifications in this samplewere as successful as school-leaver entrants (those with UK A Level qualifications).There were no significant differences between the support needs of the groups andprevious experience did not have a beneficial or significant effect on support needs.Having to maintain part-time employment significantly increased the likelihood thatstudents would consider withdrawing from the programme. For those who consideredwithdrawing but who went on to successful completion, the desire to practise occupa-tional therapy following their successful experiences in the programme was a powerfulmotivator.

Key words: computer-mediated conferencing, ethnic minorities, focus groups,international students, occupational therapy education.

Introduction

This is a report of a survey, supplemented by focus group discussions and inter-net interviews, to learn about and enhance the experience of being an occu-pational therapy student. Attention was given to issues likely to threatencompletion of the course and demand special support, with particular refer-ence to the experience of international and non-traditional UK entrants. The author was interested in attrition – students who leave the course before

Occupational Therapy International, 8(2), 107–118, 2001 © Whurr Publishers Ltd 107

*The report of a four-year continuing study into the success of students entering the BSc(Hons) Occupational Therapy degree who are other than school-leavers holding UK A Levelawards.

OTI 8(2) 3rd/JH/crc 1/2/02 11:44 AM Page 107

completion, but because these numbers are low and the data are unreliableand difficult to access, he examined graduating students who reported thatthey had seriously considered leaving the course at some point during theirstudies (para-leavers). It is understood that these para-leavers may be differentfrom actual leavers in a number of respects, but that the information they giveabout the process and outcomes they experience illuminates differences andcommonalities between segments within the cohorts.

The Oxford Brookes University BSc (Hons) Occupational Therapy degreehas an 85% record of student retention. This compares favourably with theUK average of 77% (Paterson, 1988). However, as observed by Gupta (1991),the issue of attrition in healthcare education is a critical one for all educationproviders and may be particularly sensitive where the non-traditional studentis concerned. This is crucial to the client, the profession, the students and theagencies that fund education.

The literature

Attrition: Academic ability and career choice

Paterson (1988) reported in an analysis of returns from all UK occupationaltherapy schools that the major causes of attrition among occupational therapystudents were academic failure (36%) and error in career choice (29%). Acad-emic failure may be addressed by attention to entry requirements, althoughKing (1988) suggests that good Advanced Level scores (A Levels) alone donot predict academic success. Academic difference between A Levels andother qualifications may be less important than the motivation implied bycompletion of access courses and so on.

Paterson’s second issue – mistaken career choice – requires a far greaterdegree of self-selection by students, which has always been difficult for univer-sities to achieve. The effectiveness of institutional selection assessment hasalways been in doubt and many occupational therapy courses choose to admitapplicants without interviews.

The age of students

UK occupational therapy schools traditionally welcome older students per-haps because they use their life experience to enable them to perform well.Strickland (1987) examined the effectiveness with which this group is servedand concluded that, ‘Although various accommodation strategies are beingused, programme accessibility for older students still merits further considera-tion’ (Strickland, 1987: 385). However, Schmalz (1990) found no significantrelationship between age and performance. He also, incidentally, found noeffect resulting from gender, marital status or ethnic origin. The study had 283subjects and Schmalz considers that the tests would have shown a relationshiphad one been present.

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Allied to age issues, it is possible that those coming through non-tradition-al routes – such as Access to Higher Education courses offered by colleges offurther education, and General National Vocational Qualifications – are morelikely to have made an informed career choice and to be mature in theirlearning. This is generally supported by Strickland (1987). However, there is acounter-proposition that lack of experience of learning can disadvantage astudent. Age and entry qualifications were tested by Howard and Watson(1998) in a retrospective, secondary data analysis involving 47 students. Theyfound no predictive relationship between age or entry qualification type andsuccess on the course.

Rozier (1992) sought to discover by factor analysis why students chose acareer in occupational therapy. Her conclusions included the observationthat: ‘Students were more positive about the profession if they had experienceof working in an occupational therapy department’ (Rozier, 1992: 626). Thestudy involved 225 respondents, and had a response rate of 54% from 403 dis-tributed questionnaires. This tends to support the notion that students withexperience of the profession before training have greater staying power duringthe rigours of university education.

Student stress

Two studies have identified stress at university as a cause of student failure(Jones, 1980; Haak, 1988). Walton (1997) describes a stress curve in whichperformance can be seen to fail where stress arousal exceeds the optimum,although up to that point stress is a motivator. Yuen (1990) suggested thatstress was problematic during fieldwork education in the USA. However, inthe UK, students report anecdotally in module feedback that they find thefieldwork experience highly rewarding.

Paid employment

Students at universities commonly need to undertake paid employment inorder to fund their studies. This adds to an already demanding course and maybe a factor in destabilizing a student. Paton-Saltzberg and Lindsay (1993)looked retrospectively at the reported experience of UK graduates and found asignificant inverse relationship between the pursuit of employment anddegree classification.

Summary

Academic entry level is not a satisfactory predictor of success even on theacademic component of occupational therapy courses. Motivation is describedas equally important. Poor career choice is given as a cause of failure, andexperience of the profession is related to positive attitude. The belief that

Success of non-traditional students in an undergraduate programme 109


mature students are more robust is not supported by the literature. The choicebetween purely academic entry and more practically based routes such asaccess courses is argued both ways but there is no empirical evidence for thesuperiority of either route. Stress is known to contribute to failure when thelevels exceed the individual’s personal capacity for coping with stress, but thisis a secondary result of the above factors and other life events. The require-ment to work for income alongside studies has been shown to reduce successlevels and might reasonably reduce course completion rates.

Aim

The aim of the study was to identify factors in the student experience thatrelate to attrition, with particular reference to the needs of non-traditionalentrants. This involved identifying groups of students who might be eitherparticularly robust or predictably at risk of failure to complete. Based on theliterature, the study examined alternatives to traditional entrants, consideringage, entry qualification, prior experience of occupational therapy practice andpursuit of paid employment alongside studies.

Method

Questionnaire

A questionnaire was devised, guided by Oppenheim (1992), which fell intothree general areas of enquiry, for ease of completion presented as a single,continuous document.Section 1 (antecedents): The factors leading up to the students joining the uni-versity – that is, age, gender, pre-entry qualifications, reasons for selectingoccupational therapy, reasons for selecting this university. The students werealso invited to identify, in the light of their experience, the best possiblepreparation for entry to a demanding vocational course.Section 2 (processes): Social involvement with the university, likes/dislikes ofthe course and of the institution, stress points and any consideration of dis-continuing the course, with causes and reasons for enduring.Section 3 (consequences): The outcomes of the student experience. This sec-tion elicited information about different groups of students’ perception oftheir competence to practise in various spheres of occupational therapy.

Focus groups and computer-mediated interviews

The questions were initially drawn from the literature informed by academicand practising occupational therapist focus group discussions. This wasenhanced by student focus group discussion involving minority group students,and internet interviews with individuals who considered that they were com-munity leaders in minority religious or racial groups. These were self-selected

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groups, with the attendant limitations. Discussions were semi-structured andfree flowing, and there was variance between interviews. The interviewsfocused on known barriers to the progress of individuals from ethnic minoritiesin university settings.

There were 13 quantitative questions and 11 free text questions intendedto make the completion process more satisfying and to deliver illuminationof any statistical relationships identified. Every student completing thecourse in 1995, 1996, 1998 and 1999 was asked to complete the question-naire after their final piece of study, either immediately or later for return bypost. A single reminder was issued at the point of graduation. Students weregiven an explanation of the purpose of the questionnaire and advised that,unlike module evaluation, they may give or withhold consent to take part inthe exercise. Returns were anonymous, and absolute confidentiality wasobserved.

Results

A total of 365 students were included, and there were 186 responses (51%).The results of the survey are given in three sections, which reflect the notion-al sections of the questionnaire: Section 1: antecedents; Section 2: processes;Section 3: consequences.

Section 1: antecedents

Age

Students’ ages ranged from 17 to 41 years. The mean age was 21.56 and therewas a mode of 19.

Pre-entry qualification

Students joined the course with Access to Higher Education in health or sci-ence subjects (5%), B Tech (13%) and A Levels (72%). Some 10% of stu-dents also had higher education qualifications.

Choice of occupational therapy

A total of 58% of entrants came through the careers guidance route, withonly 42% reporting direct experience of occupational therapy practice beforeentry. The number of students with experience is increasing with each cohortto reflect changing admissions practice.

Reasons for choosing the institution

The most common (34%) reason given for selecting the university was thereputation of the occupational therapy school, although convenience for



parental home was also important (33%). The reputation of the host univer-sity accounted for 15% of the choices.

Section 2: processes

Term that generated the highest levels of stress

Respondents reported least stress during the fieldwork terms, with the maxi-mum stress during the term including the dissertation, a student-directed exer-cise. This is in direct contrast to the findings of Yuen (1990). The differencemight be explained by the nature of support experienced on this course whenon fieldwork.

Students undertaking paid employment during training

Some 51% of students took paid employment, with 27% obliged to workthroughout the terms and holidays.

Students who reported considering leaving the course

A total of 37 students considered leaving the course. They did so during terms1 through 7, but term 1 was the most unstable time, when 15% of studentsseriously considered leaving the course.

Reasons given for resisting the idea of leaving the course

The most commonly reported reason for resisting leaving was a doggeddetermination to join the profession come what may, which was the reasonoffered by 54% of those students who had considered leaving. It may there-fore be considered that a primary factor in selection for the course shouldbe a strong desire (rather than simply suitability) to become an occupation-al therapist. It is also possible that a primary strategy with wavering students could be to reinforce the perception of the benefits of professionalmembership for that individual. The importance of giving early positivefeedback on performance is reported by a number of students (13%).Although an unsurprising result, this factor is not, seemingly, used well as asource of support.

Professional tutors were only infrequently reported to have played a partin assisting wavering students (9%). The way in which professional tutorsbecome involved during this critical time might justify further considera-tion. ‘Time out to consider’ was reported as helpful by a number of students(6%). This may be considered a high-risk strategy for initial application,but if a student has expressed an intention to terminate the course, thenthe application of a ‘cooling off ’ period might have a beneficial effect. Per-sonal stubbornness was reported as helpful to some students (5%). This

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might therefore be considered a useful quality in selection, but could provedifficult to measure.

Likes and dislikes

Students were asked to express likes and dislikes in two ways: (a) Whataspects of the course did they like most/least; (b) What aspects of theschool/university did they like most/least? This distinction was made in orderto elicit maximum information. It was not proposed that these questionswould deliver fundamentally different data.

Students (59%) reported a dislike for the size of the workload, citing thecomparatively lower demands of many other university degree courses. Stu-dents expressed greatest liking (53%) for the fieldwork experience.

Students were asked to respond in free text, listing the aspects of thecourse/school experience that they ‘liked’ most/least. Although the phraseolo-gy varied, it was possible to identify a number of clear themes in the responsesmade. The same themes appeared under the headings of school and course.

Paradoxically, many students referred to the same theme in both their‘likes’ and ‘dislikes’ commentary. This was not a case of one respondent likinga theme and another disliking a theme. Rather, an individual was able to seepositives and negatives in the same item.

The same list of themes is used to report ‘likes’ and ‘dislikes’ comments andthey are presented in one table to facilitate ease of reading (Table 1).

Section 3: Consequences

Theory and practice coalescing

Students found the concept of occupational therapy becoming clear fromterms 2 through 9. In 9% of cases, students remained unclear about occupa-tional therapy on graduation. The distribution is tri-modal, with each modalterm being a fieldwork term.


TABLE 1: Aspects of the course/school experience students liked most and least

Aspects of the course Most liked (%) Least liked (%)

Fieldwork 53 12Modular choice 20 0Staff 7 2Workload 0 59Gaps in the material 0 12The independence/isolation of the school 20 20The school library 21 0Opportunity to work in groups 4 1Clinical occupational therapy teaching 8 7No comment made 12 3


Comfort with their imminent role as professional occupational therapists

Some 78% of students considered themselves comfortable/completely com-fortable with their imminent role. The remaining 22% were ‘a little’ comfort-able. No students described themselves as ‘not at all’ comfortable.

Understanding of the profession

The students were asked to comment on their understanding of the concept ofoccupational therapy by considering how well equipped they felt to explain itto various others: patient/client, colleague and stranger. The student responsesshowed a distribution skewed towards ‘equipped in all contexts’, with no stu-dents describing themselves as, or near, ‘Not at all equipped in any context’.There was enough spread of responses for the question to be called sensitive.

Perception of competencies

Students were asked to rate their competency to practise in a number of skillareas, derived from the College of Occupational Therapists graduate profile.The distribution is bi-modal, spread equally between ‘not at all competent’and ‘very competent’. As such, it may be seen as a sensitive measure. No stu-dent described himself/herself as ‘Not at all competent’.

Analysis

The respondent group may be subdivided in a number of ways. Guided by theliterature, subsets were created by extracting those who have a particular char-acteristic that might affect ‘having considered leaving the course’. These setswere examined to see whether their incidence of having considered leavingthe course was significantly different from their complementary group.

The group was divided as follows:

(1) A Level entrants were compared with students who joined the coursewith other qualifications.

(2) Students aged 25 years and over were compared with students under theage of 25.

(3) Students who took up paid employment during the taught terms werecompared with those who did not.

(4) Students with experience of the profession before joining the course werecompared with those with no experience.

The likelihood of each subgroup having considered leaving the course

To assess whether minority groups were more or less robust than their comple-

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mentary groups, the percentages of students in each subgroup who had consid-ered leaving the course were compared. It was found that students with non-traditional qualifications and students following term-time employment weremore likely than their counterparts to consider leaving, and older studentsand those with direct experience of occupational therapy were less likely toconsider leaving. However, most of these differences could be accounted forby random fluctuations.

Statistical analysis

Pearson’s Chi-square test for association between categorical data was applied,and it did not show statistical significance for either the high risk apparentlyassociated with non-traditional entry (p=0.827) or the low risk associatedwith the older student (p=0.162) and the student with previous experience(p=0.08). This may indicate the absence of any relationship, but the numberof students does not confer sufficient power to entirely rule out a type 2 error.A statistically significant relationship was shown between term-time working(p=0.05) and considering leaving the course.

Logistic multiple regression was used to examine the effects of each ofthese factors, after allowing for the others. However, it failed to show any rela-tionship between the factors tested.

The speed with which theory and practice coalesced

Analysis of variance tests showed no significant difference in confidencebetween the subgroups and their counterparts in terms of the speed withwhich theory and practice coalesced.

Confidence with imminent professional role

Analysis of variance tests showed no significant difference between theexpressed confidence between the subgroups and their counterparts in termsof ultimate confidence with their imminent role.

Level of understanding of the profession

Analysis of variance tests showed no significant difference between the sub-groups and their counterparts in terms of the perceived level of understandingof occupational therapy.

Level of perceived competence to practise

Analysis of variance tests showed no significant difference between the sub-groups and their counterparts in terms of perceived level of competence topractise occupational therapy.



Discussion

The aim of the study was to identify factors in the student experience thatrelate to attrition, with particular reference to the needs of non-traditionalentrants. This involved identifying groups of students who might be eitherparticularly robust or predictably at risk. Based on the literature, the studyexamined alternatives to traditional entrants, considering age, entry qualifica-tion, prior experience of occupational therapy practice and pursuit of paidemployment alongside studies.

The exercise does not show any statistically significant difference in thelikelihood of having considered leaving the course between members of thethree categories a), b) and c) below, and their complementary groups:

a) students who joined the course by other qualifications (not A Levels);b) students aged 25 years and over;c) students with experience of the profession before joining the course.

However, d) students who took up paid employment during the taught terms were

significantly more likely to have considered leaving the course.

There was no distinction between these groups with regard to their learn-ing success or outcomes.

Non A Level students report no greater need for learning support and showa level of competence and confidence to practise indistinguishable from thoseof A Level entrants. This gives weight to the ideas of King (1988) and alignswith the findings of Howard and Watson (1998). It supports growing practiceto encourage a rich mix among occupational therapy students and generallywiden the entry gate.

Older students (aged 25 and above) show the same confidence and compe-tence as younger students, and report a lower incidence of considering leavingthe course than do their younger colleagues. However, this improved robust-ness is not statistically significant, as was also found by Howard and Watson(1998) and Schmalz (1990). Increased stability would add to the attractive-ness of this group, although they already have a number of advantages. The working life expectancy of a 40-year-old graduate seems to be shorter (25 years) than that of a 22-year-old graduate (43 years). However, whileavoiding generalizations, the increased likelihood of long-term local residenceand the reduced likelihood of career breaks may make a 40-year-old the gradu-ate of choice for many local bodies commissioning education.

Students with professional experience of practice prior to admission do notshow significantly better performance in terms of robustness or outcomes thanthose who have no formal experience. However, benefit may be being maskedby the general requirement that applicants gain experience through voluntarywork or extended visits as a part of the selection process. Therefore, the failureof this statistic to support present practice should not be taken as justificationfor discontinuation of the practice. Rather, it may reflect the success of the

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practice of requiring experiential visits. As stated by Paterson (1988) andRozier (1992), informed career choice is critical and the respondents reportthat a strong career anchor was valuable in sustaining them when in doubt,even though it does not protect them from considering leaving the course.

A significant difference is evident between entrants who pursue paidemployment during term time and those who do not: of the students pursuingemployment during term time, 40% considered leaving the course, whereas ofthe students not pursuing employment during the term only 31% consideredleaving. The relationship aligns with a growing concern in higher educationregarding student employment and its impact on the learning experience, asdescribed by Paton-Saltzberg and Lindsay (1993). Although there is a rela-tionship in this area, the nature of that relationship is not demonstrated. Itmight be that the extra time demand on a student in a cohort that complainsof an excessive academic workload is sufficient to destabilize members of thisgroup. Alternatively, it might be the case that there is financial pressure onthe student that causes him/her to seek employment and to consider with-drawing from the course. For universities to respond to this issue is problemat-ic. To recruit students who will not need to work would be unacceptable, andwould be socially divisive and against the egalitarian progress enjoyed in high-er education. It may be argued that for a government to impoverish studentsthrough inadequate grants, bursaries and loans is not cost effective if it leadsto increased attrition rates and waste of learning resources. Universities mayhelp by making appropriate paid employment available to students, thusensuring that respectable rates of pay and acceptable hours of employment areavailable. Occupational therapy students reported that they were disadvan-taged in the student job market because they are periodically posted away forfieldwork education, during which time they risk losing any paid employment.

There seem to be some danger periods when students consider leaving thecourse and when professional tutors must be particularly vigilant. The need toencourage a high volume of learning in term 1 as preparation for the futureproduces a dynamic tension in this context. The reasons given by studentswho considered leaving but decided to stay are relevant to this first term. Itmight stabilize the student if the expectation of becoming an occupationaltherapist was reinforced at that time, because if graduation seems impossiblyfar off it will lose its motivational value. Early study successes would also havea beneficial effect, but if educators give primarily critical feedback at this stagefor formative benefit then this may demoralize individuals when they mostneed help. It is common for students in the first term to receive high profes-sional tutor attention, but this was rarely given as the reason that studentsresist the urge to leave the course. Fieldwork education periods are reported astimes when the training becomes more comprehensible and less stressful andwhere student support may be less critical. However, the importance of sup-porting fieldwork educators and the catastrophic nature of problems that doarise may justify continuing high support.



Conclusion

The results show a significant relationship between working during the taughtterm and feeling so stressed as to consider leaving the course. The study showsno difference between the process and outcome experiences of students withA Level entry and those with other qualifications or between older andyounger students.

Acknowledgements

The author gratefully acknowledges the following, who made contributions toquestionnaire design and administration: Anita Warnford, Elizabeth Burrows,Margaret Shanahan and Jennifer Butler.

References

Gupta G (1991). A challenge for allied health programmes. Journal of the American MedicalAssociation 266(7): 963–7.

Haak M (1987). Alcohol use and burnout among nursing students. Nursing and Health Care 8:298–301.

Haak M (1988). Stress and impairment among nursing students. Research in Nursing andHealth 11: 125–9.

Howard L, Watson M (1998). A degree in occupational therapy. How do traditional and non-traditional entry routes compare? British Journal of Occupational Therapy 61(6): 244–8.

Jones J (1980). The Staff Burnout Scale For Health Professionals. London: House Press.King A (1988). Selection of students for occupational therapy. British Journal of Occupational

Therapy 51(8): 265–6.Munroe BH, Page EB (1993). Statistical Methods for Health Care Professionals. Philadelphia,

PA: Lippincott.Oppenheim A (1992). Questionnaire Design, Interviewing and Attitude Measurement. Lon-

don: Pinter.Paterson CF (1988). Annual survey of occupational therapy students: Reasons for dropouts.

British Journal of Occupational Therapy 51(3): 81–3.Paton-Saltzberg R, Lindsay R (1993). The effects of paid employment on student performance.

Teaching News 34: 10–11. Rozier C (1992). Why students choose occupational therapy as a career. American Journal of

Occupational Therapy 46(7): 626–32.Schmalz G (1990). The use of pre-admission data to predict levels of success in selected allied

health students. Occupational Therapy Journal of Research 10(6): 367–76.Strickland LR (1987). The ability of professional programmes in occupational therapy to

accommodate the older student. American Journal of Occupational Therapy 41(6): 382–7.Walton M (1997). Management and Managing. London: Stanley Thornes.Yuen HK (1990) Fieldwork students under stress. American Journal of Occupational Therapy

44(1): 80–1.

Address correspondence to Neil Wheeler, Principal Lecturer, Occupational Therapy, OxfordBrookes University, Dorset House, 58 London Road, Headington, Oxford OX3 7PE. [email protected]

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Documents

Success of non-traditional students in an undergraduate occupational therapy programme