expert_review_ot by yaofenji


									OT Program Review 2/24/2010




  Submitted to the Special Program Review Committee
           and the Academic Vice President
                     February 2010

                    Kate Hayner, EdD, OTR
                  Chair, Occupational Therapy
                  Abby M. Heydman, PhD, RN
                Professor Emeritus & Consultant

OT Program Review 2/24/2010

                              TABLE OF CONTENTS

I      Introduction                                                3

II     Program History and Transitions in Occupational Therapy     3
            Certification, Registration, and Licensure             5

III    Quality Assurance and Program Review at SMU                 5

IV     Statement of the Problem                                    5
             Potential Issues to Explore                           6
             Methods Used for Special Program Review               6

V      Admissions Standards, Policies, Practices                   7
             Admission History Class of 2009                       9

VII    Curriculum                                                  10

VIII   Clinical Education in Occupational Therapy                  12

IX     Faculty                                                     13
X      Other Findings                                              15
       Survey of Class of 2008                                     15
              Analysis of Emails from Graduates                    17
              Telephone Interviews with Students Who Failed Exam   17

XI     The NBCOT Certification Exam                                18
             Changes in the NBCOT Certification Exam               18
             Time Management During the Examination                20
             Scheduling the NBCOT Exam                             21
             Exam Preparation Within the OT Program                21

XII    Problem-Based Learning                                      21

XIII   Department Financial Performance                            22

XIV    Future Plans of the Department                              22

XV     Departmental Action Plan                                    22

XVI    Recommendations                                             24

OT Program Review 2/24/2010

     Table 1:   SMU Pass Rate of First-Time Certification Exam Takers
     Table 2:   Applicant Pool, Acceptances, and Entering Class Data
     Table 3:   Entering Cumulative GPA of OT Classes
     Table 4:   History of OT Admission Requirements

    Appendix 1. Interview Transcripts                                   27
    Appendix 2. Financial Data                                          28

OT Program Review 2/24/2010

                          Samuel Merritt University
                      Department of Occupational therapy
                              Program Review

                                   February 2010

Samuel Merritt University (SMU) engages in regular quality assurance processes
to validate that it is accomplishing its mission. Targets are set for key indicators
of performance across programs and departments. Unusual variance in
achievement of these targets triggers a mandatory special review in addition to
those regular reviews normally scheduled at five year intervals. The purpose of
this document is to report on a Special Program Review, triggered by an
unanticipated and significant decline in graduating student performance on the
national certification examination in occupational therapy.

The OT program has weathered many ups and downs in enrollment over the
years, but performance of graduates has remained above the national average in
terms of program outcomes for the past five years. Results from the class
entering in 2006 and graduating in late 2008 clearly deviated from this pattern.
Early indications of a change in performance on the OT credentialing
examination became evident in late summer when monitoring of pass rates
which are available online indicated that, with most but not all results being
posted, the first-time test-taker licensure pass rate appeared to be around 56%.
Subsequently one additional student has successfully passed the exam on the
first attempt for a cohort pass rate of 58% in 2009. Somewhat surprising
however, was data that also indicated all students had subsequently passed the
exam. This is somewhat atypical, as pass rates among repeaters on licensure
exams are often fairly low.

Program History and Transitions in Occupational Therapy
The OT program was founded in 1998 and has offered a master’s degree
program preparing graduates for entry-level positions in the field. The program
was developed based on professional and regional accreditation standards,
contemporary expectations for entry into clinical practice, and the philosophy of
the faculty. The Guide to Occupational Therapy Practice, published in the
American Journal of Occupational Therapy (1998) and the Occupational Therapy
Practice Framework, published by the American Occupational Therapy
Association (2003) provide direction for the curriculum. The philosophy of the
faculty also drives the curriculum, including the use of a thematic concept of the
“whole person” or holism. In addition, the theoretical foundation of the program is
based on the work of Adolph Meyer, who believed that human occupation follows
the biological rhythms of life, including work, play, rest, and sleep, which offer the
physiological and psychosocial balance needed to thrive.

OT Program Review 2/24/2010

In 2001, the Department of Occupational Therapy was placed on emergency
watch due to a substantial drop in the number of students admitted from their
traditional 40 students per year to eleven. This occurred as a result of the
Balanced Budget Act of 1998, which had a profound effect on the OT job market,
and subsequently on applications for admission. A decrease in overall applicant
quality also resulted in a significant decrease in aggregate national board exam
results of graduates.

The President of SMU placed the program on emergency watch for these
reasons, in addition to decreasing the OT operational budget substantially to
minimize the overall negative effect on the financial stability of the College. The
President also convened a faculty/staff committee to make recommendations
that might help the department improve its viability and effectiveness. Over the
next few years, the OT faculty conducted a comprehensive review of the
curriculum, adjusted admission requirements, instituted an action plan to improve
licensure pass rates, established articulation agreements with Saint Mary’s
College and Hawaii Pacific College; developed a new marketing brochure, and
added a new mental health clinic experience. The interim program Chair was
appointed to the Chair position, and faculty mobilized around new departmental
leadership. A recommendation to explore moving to an entry-level doctoral
program was considered but not vigorously pursued. Measures taken during this
period stabilized the program, improved the applicant pool, significantly improved
performance of graduates on the licensure exam, and enabled the program to
significantly enhance its financial contribution to the University.

When the OT program was founded, a majority of OT programs were offered at
the baccalaureate level. The profession was in transition, having lost many of its
employment venues in the psychiatric field as mental health facilities closed and
drug therapy moved treatment to outpatient settings. However, new
opportunities were developing, particularly in work with both an aging population
and children experiencing development delay. Today, occupational therapists
can be found in most schools, pediatric hospitals, rehab centers, skilled nursing
facilities, and acute care centers.

Recognizing the trends in the field and the demands involved with meeting new
needs, Samuel Merritt developed a master’s degree as its entry-level degree.
The master’s degree became the official requirement for program accreditation in
2008. Although there has been a healthy debate about the need for an entry-
level doctoral degree in occupational therapy in recent years, there is little
consensus within the OT academic or professional community on this notion.
While there are a few entry-level doctoral programs being offered, these are the
exception rather than the rule. Occupational therapists generally seek specialized
certification as a means to advance within the profession. Areas of advanced
specialization include adult rehabilitation, pediatrics, and hand therapy. There are
a number of emerging areas of practice include ergonomics, vision rehabilitation,

OT Program Review 2/24/2010

community consultation, driver rehabilitation, and working with elders in assisted

 Although demand for occupational therapists has varied considerably over its
history, with a dramatic downturn in job outlook following the Balanced Budget
Act of 1998, the field is currently experiencing a shortage of therapists and
therapists are in high demand. This has significantly improved salaries for OT’s,
something which has provided a new challenge for SMU in recruiting
experienced faculty. The entry-level salary for an occupational therapist at the
University of California San Francisco is $67,212 and $68,640 at Alta Bates
Summit Medical Center.

      Certification, Registration, and Licensure in Occupational Therapy
Students who graduate from accredited OT programs are eligible to take the
certification exam offered by the National Board for Certification of Occupational
Therapists (NBCOT). Successful passing of the exam leads to national
registration and the right to use the credential OTR. Some, but not all states,
require occupational therapists to be licensed to practice within state boundaries.
California passed a mandatory licensure requirement for OTs about ten years
ago. As a result, OT’s practicing within California must graduate from a
professionally accredited OT program, pass the certification examination, and
pay a California licensing fee.

Quality Assurance and Program Review at Samuel Merritt University
All of SMU’s programs are guided by professional accreditation standards and go
through a rigorous external review by the accreditation agency at regular
intervals. The accrediting agency for OT is the Accrediting Commission for
Occupational Therapy Education (ACOTE). The last ACOTE review of the OT
program was in 2008. The Commission verified that the program was in
compliance with accreditation standards and that there was strong evidence that
it was meeting its mission. Only minor recommendations were made for program
improvement. The program was re-accredited for ten years, the maximum length
of time.

As of 2007, SMU programs are also required to complete an internal program
preview at regular five-year intervals. The OT program was scheduled for such a
review in 2011. This schedule was pre-empted with the decline in first time
licensure exam pass rates in 2009, a finding which requires the department to
undergo the current Special Program Review.

Statement of the Problem
The primary problem to be explored in this Special Program Review is the
significant decline in the pass rate of first-time test-takers for the OT licensure
exam among the graduates of the class of 2008. These students matriculated in
the OT program in September 2006 and completed final clinical rotations in late
2008. Normally, the OT program is completed within 28 months of matriculation,

OT Program Review 2/24/2010

though this varies slightly among students depending upon when final clinical
rotations can be scheduled. With one exception, students from the entering class
of 2006 took the licensure exam in early 2009. Table 1 provides data on the
pass rate of OT first time test takers since the inception of the program.

       Table 1: SMU Pass Rate of First-Time Certification Exam Takers in OT

 Year            2000   2001   2002   2003   2004   2005   2006    2007    2008    2009
 Pass Rate %     93%    77%    72%    74%    100    100    90.91   85.19   85.71   58.13
                                             %      %
 Number of       37     29     19     9      12     18     28      35      25      31

                            Potential Issues to Explore
Performance on licensure examinations can be affected by many factors, but
typically include the selection criteria for admission, quality of the curriculum and
clinical education, preparation and skill of the faculty, test taking skill and
experience of students, and the nature of the licensure exam itself. For this
reason, this Special Program Review examined many potential factors which
could be at play in the performance of recent graduates.

                  Methods Used for Special Program Review
The program review was conducted by Kate Hayner, Chairman, and Abby M.
Heydman, PhD, consultant, professor emeritus, and former SMU Academic Vice
President. A variety of methods were used to complement data already available
in the extensive outcome data set on performance of OT graduates.

       A special survey of the class of 2009 was undertaken focusing on
        graduates’ experience with the NBCOT licensing examination. The
        purpose of the survey was to assess methods used by the students to
        prepare for the exam, perceptions of the effectiveness of their preparation
        by the program for the exam, impact of the new NBCOT test blueprint, and
        to identify those strategies that were perceived as most helpful in passing
        the examination.
       Follow up phone interviews with three students who had failed on the first
        attempt were also completed. This step was taken to drill further down into
        the explanation for the increased number of failures.
       Analysis of email communication from students to an OT faculty member
        regarding the exam was also completed.
       Interviews were conducted with core OT faculty and the chair of the OT
        Basic Sciences department, who had experience with this cohort from the
        time they entered the program.
       Interviews were also conducted with two staff members in the Admission
        department who were most involved in the admission of the 2009 cohort.

OT Program Review 2/24/2010

        A comparison study was completed of OT admission and curriculum
        requirements to determine whether the SMU curriculum in OT is
        comparable to a select group of OT programs.
       A review of data was completed on the class of 2009, looking at the
        admissions scores on the three areas of the GRE, the cumulative GPA,
        science GPA, the number of science courses each student had in
        relationship to passing or failing the NBCOT exam on the first attempt.
       And finally a phone interview was done with the Chair of the OT program
        at Creighton University, both to explore issues around the credentialing
        exam and to discuss the entry-level doctoral program as an option in OT

Admissions Standards, Policies and Practices
The OT program has modified its admission standards over the years in the
departments attempt to establish admission criteria that would enable the
program to select students who could benefit from instruction and be successful
in the field, while at the same time, not creating barriers to admission which could
have a negative impact on enrollment. As noted previously, the OT program has
had ups and downs in its enrollment throughout its history. Like PT, it was
negatively impacted by the Balanced Budget Act in 1998 which created a
downturn in the job market and the applicant pipeline which was most evident
from 2002 through 2004. In addition, OT is not a field with which many
prospective students have experience, so the applicant pool have remained
modest nationwide at the same time the number of programs has expanded.
Currently there are 142 accredited entry-level master’s degree programs and 4
entry-level doctoral programs on OT. There are two critical competitors in the
region: San Jose State University and Dominican University. Historical data on
the applicant pool for OT can be found in Table 2.

          Table 2: Applicant Pool, Acceptances, and Entering Class Data

   Year of      Number of      Number of       % of       Entering     % of
  Admission     Applicants      Students     Applicants    Class     Applicants
                              Accepted for   Accepted      Size       Enrolled
       2009        128             52          41%          36          69%
       2008        108             60          56%          38          63%
       2007         67             54          41%          35          65%
       2006         71             52          73%          27          52%
       2005         58             48          83%          35          73%
       2004         58             53          91%          28          53%
       2003         50             43          86%          23          53%
       2002         32             26          81%          16          62%
       2001         31             25          81%          10          40%
       2000         55             51          93%          21          41%
       1999         92             75          82%          33          44%
       1998        110             48          44%          43          90%

OT Program Review 2/24/2010

Current admission requirements required to be considered for an admission
interview for the OT program include:
     Completion of a baccalaureate degree and all prerequisites from an
        accredited institution.
     Suggested cumulative minimum GPA of 2.8 for the last 60 units
     Suggested minimum science GPA of 2.6
     Satisfactory interview
     TOEFL score of 100 (if profile indicates a need)
     Evidence of 60-70 hours of work or volunteer experience demonstrating
        an understanding of the occupational therapists role and maturity in career
     Two letters of reference, one from a registered OT and one from an
        academic source.

Prerequisite coursework includes coursework in English, social sciences,
statistics, and general biology. Courses in anatomy, physiology, physics, and
public speaking are highly recommended but not required.

The data for the mean GPA of each entering class is displayed in Table 3.

               Table 3: Entering Cumulative GPA of OT Classes

              Mean entering GPA                       Year
                    3.21                              2009
                    3.26                              2008
                    3.14                              2007
                    3.06                              2006
                    3.15                              2005
                    3.14                              2004
                    2.87                              2003
                    3.14                              2002
                    3.05                              2001

As noted above, the average GPA has increased over the past few years with
the exception of the class of 2006, the cohort that performed poorly on the
certification exam this year. However, the Mean GPA for the entering class in
2006 was 3.06, well above the required GPA. A review of admission criteria
since program inception suggests that the downturn in the applicant pool in 2002
and concerns about program viability led to increasingly flexible and less
stringent admission requirements for OT applicants. A review of admission
requirements for comparable health science programs at SMC (nursing, PT, PA)
reveals admission requirements that are much more selective. Fortunately, the
quality of the OT applicant pool has increased since 2007. This has enabled the
faculty to take modest steps to improve selectivity in the admissions process.

OT Program Review 2/24/2010

Historical changes in OT admission requirements and an explanation for each
change are captured in Table 4.

                 Table 4: History of OT Admission Requirements

      Requirement               For Students                  Rationale
                               Entering (Year)

Dropped required courses circa 2002               Anatomy and physiology are
in Anatomy & Physiology                           impacted courses on many
as prerequisites                                  campuses and students could
                                                  not always get these courses in
                                                  a time way. Overall academic
                                                  aptitude is considered the most
                                                  important factor in admission.
Dropped                      2007                 Analysis indicated that the GRE
required GRE Exam                                 did not predict success and
                                                  was a potential barrier to
Ranking of candidates        2009                 Selection procedures changed
begins and wait list                              from selection of those who
created                                           merely meet requirements to
                                                  ranking of best candidates
Added points for             2010                 Additional points in ranking
completion of Anatomy &                           process for applicants who
Physiology coursework                             have successfully completed
before admission.                                 Anatomy & Physiology before
                                                  admission. Refined the ranking
                                                  criteria. Formalized the scoring
                                                  for the writing sample.

An excel spread sheet was completed for the class of 2009 with data about the
admissions scores including the last 60 unit cumulative GPA, science GPA, the
number of science courses taken prior to admission, as well as the GRE scores
(analytical, verbal, and quantitative) which were required for this class. Because
the n is only 23 students, the data cannot be analyzed for statistical significance
but two trends were noted as having a larger proportion of passing students (on
the NBCOT exam) and may warrant some further discussion. One trend was the
higher percentage of students passing the NBCOT exam on the first attempt
when the GRE analytical score was higher. This same trend was noted in those
with a higher science GPA. Again, to understand if this is indeed has statistical
significance, a much larger n would be required.

                      Admission History Class of 2009
       A member of the Admission staff member was initially responsible for
recruitment and admission of the OT Class of 2009. However, this staff member

OT Program Review 2/24/2010

was enceinte and took a maternity leave in the midst of the admission cycle for
the 2009 cohort. A second staff member, a very experienced professional, filled
in for the assigned staff member during her maternity leave. Unfortunately, the
substitute staff member experienced two tragic sudden deaths among her
significant others during this period. Interviews were conducted with both staff
members for purposes of this review. The first staff member had a vivid
recollection of the 2009 class and noted that when she returned from maternity
leave, she was sorry to learn that a number of strong applicants, who had initially
accepted admission into the program and paid a deposit, had subsequently
withdrawn. On the other hand, substitute staff member had minimal recall of the
class and initially indicated that she had not been the replacement staff member.
However, a look at student records indicated that she had been the staff person
who had drafted the admission letters for most members of this class. She also
noted that the final entering class included at least two students who initially
applied to the PT program and were denied admission. Overall the program did
not meet its enrollment target that year and the cumulative GPA of the entering
students was the lowest in some years. It appears that a set of unique
circumstances may have been at play during this admission cycle, leading to the
admission of slightly lesser academically-prepared students.

The faculty completed a comprehensive curriculum review in preparation for
reaccreditation by ACOTE in 2008. No curriculum citations were noted and the
program was awarded the maximum possible period of accreditation, ten years.
Recently approved accreditation requirements mandate a progress report during
the interim period. As a second check on the credibility of the OT program,
curriculum data were collected from five OT programs reputed to be among the
top in the discipline and one major local state university. These include New
York University; University of Washington, Seattle; Washington University, St
Louis; University of Southern California, Los Angeles; Boston University; and San
Jose State University. The complete data set for the six schools is available in
the Appendix of this report.

For the purpose of curriculum comparisons, data were collected on the number
of prerequisite science courses required for admission, as well as the foundation
science courses required in the OT curriculum of the six programs. There was a
wide range in number of courses and units required in both categories. Samuel
Merritt requires somewhat less than the median pre-requisite science courses
but makes up for this in demanding a somewhat higher number of units within the
prescribed OT curriculum. When the two science categories are viewed as a
whole, the prerequisite science units and those required in the SMU curriculum
add up to six courses and 22 semester units of credit in total, numbers which are
exactly at the median number of units required by the six comparison schools.

It is the opinion and observation of the Chair of the Basic Sciences Department
that overall academic aptitude is the best indicator of success in OT, rather than

OT Program Review 2/24/2010

the number of prerequisite science courses. Since additional science
requirements could be a barrier to admission (particularly in the current funding
crisis for California public colleges and universities which has decreased the
availability of course offerings), it is not recommended that a change be made in
prerequisite sciences courses at this time. The recent decision to add points in
the admission ranking process for those students who have completed courses
in Anatomy and Physiology is a reasonable strategy to improve the selectivity of
those admitted.

The SMU curriculum in OT includes core science requirements in anatomy,
physiology, and kinesiology in the first year of the program. These courses could
be required as prerequisites but the faculty has chosen to include them within the
professional curriculum. Currently, two courses (8 units) are devoted to both
physiology and anatomy and two courses (4 units) are devoted to kinesiology.
The inclusion of these requirements has given the SMU program a reputation for
scientific rigor. Many of the OT students report that they picked the SMU program
due to the science reputation and the cadaver work in anatomy.

On the other hand, feedback from students in recent years has suggested that
the coures in Kinesiology are too time consuming compared to other core
courses in the OT curriculum. Last year the chair of the program completed a
survey of students to collect data on the number of hours students spent outside
of class in preparation for each course in the first year of the program. The
results of the study showed that the Kinesiology classes took a significantly
greater amount of outside study time than other classes, possibly impacting the
amount of learning in concurrent classes. A plan of action to reduce the amount
of time required for kinesiology was put into place by the instructor and was
presented to the OT faculty last spring. Follow up will be done in the current
academic year to assess the impact of this plan.

Another question raised during this review was whether the number of units in
OT foundation and theory courses should be increased in the curriculum, given
the performance of the 2009 cohort on the licensure exam. However comparison
data for OT foundational courses and theory courses indicate that as a whole,
SMU is right at the median in its curriculum requirements among the six
comparison schools. As noted earlier, no curriculum issues were raised during
the 2007-2008 external review of the curriculum by ACOTE. In addition, both
survey and interview data of the 2009 cohort conducted for this review indicate
that students feel well prepared for their discipline by the present curriculum.

Fieldwork requirements are exactly the same across OT programs due to
accreditation standards. While some programs report more units in fieldwork,
this is related to their particular campus methodology for awarding units of credit
rather than reflecting real differences in clinical requirements. Some schools,
including SMU, permit students to take an additional clinical rotation as an
elective, but this is not factored into the statistics provided. Again, both the

OT Program Review 2/24/2010

previous external review by ACOTE and results of a survey and interviews with
the 2009 cohort do not indicate there are any serious problems with OT clinical
education at SMU.

The comparison of curriculum topics and courses across the six schools also
included business and professional classes in OT, as well as psychosocial
prerequisites and psychosocial classes in the program. While again there was a
wide range of requirements across programs as was true in the area of science
and OT content, current curriculum requirements for OT students at SMU closely
reflect the median number of units required across the comparison programs in
both business and professional coursework and psychosocial courses within the
program. However, SMU does require slightly more psychosocial coursework
prior to admission than comparison schools. In addition, the OT department has
recently responded to feedback from OT alumni and clinical fieldwork preceptors
by adding an additional unit of core psychosocial content prior to students
initiating fieldwork. .

In summary, the SMU curriculum generally reflects current standards and
common practice among OT programs. There was no evidence that the program
is out of alignment with other OT programs in key areas of focus. In addition,
evidence indicates the program continually monitors and uses feedback from
students and other stakeholders to study or modify the curriculum as needed.

Clinical Education in Occupational Therapy
As noted earlier in the previous section, the fieldwork component of the OT
program is comparable to that of other OT programs offering the master’s
degree. Twenty-four weeks of clinical rotations are required of students in the
program and are accomplished through clinical rotations in clinics sponsored by
the OT department and a series of culminating clinical rotations in which students
work under the direct supervision of a clinical instructor provided by an agency
with which the program has a contract. Ideally, clinical fieldwork exposes
students to a wide variety of conditions and provides an opportunity for the
application of assessment, planning, and intervention skills typically required of
the occupational therapist. Data from the survey of the 2009 cohort and
interviews with students who failed the exam indicate that students, with rare
exception, were satisfied with their fieldwork experience and found that it did
enhance their preparation for practice and the credentialing exam.

Faculty advises students prior to their final off site clinical rotations that they
should have a regular study plan during final clinical rotations for the
credentialing exam. The interviews with a small sample of students who failed
on their first attempt to pass the exam suggest that this may not be a realistic
expectation. Students indicated they are very busy with their final clinical
rotations. They are seeing a wide variety of cases, experiencing their first acute
care scenarios, and are doing frequent presentations within their agency. As a
result, students report they are exhausted at the end of the day and not inclined

OT Program Review 2/24/2010

to study for the exam intensively during this period. Study done during fieldwork
is mostly related to the cases they are seeing in their clinical site. In addition, the
three students interviewed for this review indicated that they and their classmates
needed a short break before starting their exam preparation due to burnout and
fatigue. This might be an area for further study in the future to determine
whether this is a shared experience among the majority of students.

SMU faculty provides immediate supervision for the first three clinical courses in
psychiatric, adult, and pediatric occupational therapy. Students select final
clinical rotations in consultation with the OT Fieldwork Coordinator, who works to
find an optimal fit which will maximize student learning, taking into account
student performance in the program and strengths and weaknesses noted by
faculty. Selection of final clinical rotations is done with consideration for student
needs and interests, as well as the availability of clinical sites. Once students are
placed in their final rotations, the Fieldwork Coordinator interacts primarily with
students or preceptors who report having difficulty meeting learning objectives.
There is also a mandatory mid-semester meeting between the Fieldwork
coordinator and the students. Students are advised on how and when to contact
the Fieldwork Coordinator, but direct contact is rare (beyond the required
meeting) unless intervention is required. Informal discussion with other clinical
coordinators indicates this is not atypical. Although early on a question was
raised about the lack of contact with OT students during their final clinical
rotations, this concern was not raised by students in either the survey or
interviews with students. Students interviewed by the consultant for this project
indicated they felt well prepared to begin their final rotations, knew how to reach
the Fieldwork Coordinator if needed, had confidence she would provide support
as necessary, and did not feel additional supervision was required. Program
evaluation data over a long period of time (graduating student data, alumni
surveys) have indicated that clinical education for OT students at SMU has been

In summary, there was no evidence to suggest that deficiencies in clinical
fieldwork were at play in terms of the performance of the 2009 cohort. However
Interviews and discussions with both the OT Fieldwork Coordinator and staff
holding similar positions in other programs at SMU indicate that fieldwork
education occurs within professional silos across the campus. There is virtually
no dialogue or sharing of best practices or resources for the training of clinical
faculty across programs. This finding warrants further attention.

There are six full time and pro-rata faculty in the OT department who serve as
the core faculty responsible for curriculum, clinical instruction, academic policies,
and assessment of outcomes. The department is led by Kate Hayner, EdD, OTR
who has held the position of chair since 2002. The core faculty has been
remarkably stable over the years with only one recent full time faculty member
added in 2008 after a protracted search. The OT faculty meets regularly to

OT Program Review 2/24/2010

discuss curricular issues, student performance, and trends and issues in the

Interviews were conducted with the core faculty who were in place when the
class of 2009 was admitted. All have taught these students in one or more
classes. In general, faculty as a whole considered the 2009 class as a
somewhat weaker cohort academically. On the other hand, although both
science and cumulative GPA’s of the entering students were lower than previous
and subsequent groups of students admitted to the program, faculty members
were surprise at the significant number of students who failed the licensure exam
on the first attempt. The faculty perception is that the curriculum has been
stable, more than covers essential content and learning experiences needed to
practice OT, and performance outcomes of graduates have validated the
credibility of the curriculum over time.

Faculty were deeply concerned about the decline in student performance on the
exam and quickly rallied to address factors which might be at play. One faculty
member, an item writer for the exam, noted that one difference for this class is
that she has voluntarily held review sessions on the exam for students in prior
years but was unable to do so for this class because of other demands on her
time. Several students sought her help following their initial failures and she did
provide counsel and advice to those students.

One thing that became apparent during faculty interviews is that the faculty has
somewhat disparate views on standards and rigor needed in the program.
Similarly, there does not appear to be consensus on expectations regarding
professional behaviors for students, (or the faculty role in addressing these),
resulting in some students reaching final clinical rotations with inappropriate
behaviors in areas such as reliability, timeliness, professional demeanor, and
work ethic. The faculty does discuss students who are having difficulty in a
particular class or clinical rotation during faculty meetings and provide input on
action plans. Somewhat surprisingly however, there is no annual review of each
student’s performance and behaviors in regard to outcomes expected at each
level of the program. This is generally considered a best practice to ensure that
potential problems are caught early in a program (and not on final rotations).

The faculty complement includes three faculty members with doctoral degrees,
two fieldwork coordinators and two additional faculty members whom all hold
post professional master’s masters degrees. Faculty holding masters degrees
should be strongly encouraged to develop plans for doctoral study as is
appropriate for faculty teaching in graduate education. Doctoral preparation of
faculty will also be important should further consideration be given to offering an
entry-level doctoral degree or post-professional doctoral degree in the future. The
current accreditation standard requires that 50% of the full time faculty in the
department hold a doctoral degree. This is just being met but if any of the
doctoral faculty left their position the program would be out of compliance with

OT Program Review 2/24/2010

this standard. Current efforts are underway to improve faculty salaries, a
necessary step to ensure retention and recruitment of qualified faculty.

Other Findings

                            Survey of the Class of 2008
A survey was sent to the members of the class of 2008 for whom current email
addresses were available. Twelve graduates responded, six had passed the
exam on the first attempt, six had not. Four of the grads who failed on the first
attempt gave permission for follow up contact by telephone interview. Of these,
three were reached and results of these interviews are summarized later in this
report. Fifty percent of the respondents reported they took the exam within two
months following program completion. Twenty-five percent of the cohort took the
exam within three months. Three graduates reported they did not take the exam
until four or more months following graduation. Reasons for this varied, with two
respondents reporting that the death of a family member or close friend was a
factor. Since scheduling of the exam close to the time of program completion
appears to enhance success, future students will be advised not to delay taking
the exam.

Eighty-three percent of the graduates reported that SMU prepared them very well
or moderately well for the exam. Two graduates reported the program somewhat
prepared them for the exam. None of the students indicated that the OT program
left them somewhat unprepared or not prepared for the exam.

Although the majority of students indicated that Fieldwork helped them to be very
well, moderately, or somewhat prepared for the exam, one student indicated that
Fieldwork left him/her somewhat unprepared. Study preparation and review,
knowledge of the test format, time management during the test, and test taking
strategies were all viewed as Important in passing the exam on the first attempt.
Two graduates reported they were somewhat unprepared in test taking strategies
and one reported that time management skills in getting through the exam were
an area in which she felt unprepared.

Ninety percent of the graduates responding to the survey indicated they had
purchased a self-study exam book to prepare for the credentialing exam. Other
methods to prepare for the exam for was self-study (all students), with all but one
graduate indicating that group study was also helpful. Use of NBCOT practice
exams was also rated as very helpful by a majority of respondents. Graduates
who failed the exam on the first attempt reported that additional self-study and
use of NBCOT practice exams were very helpful in their preparation. Two grads
reported that they took a Therapy Ed test prep courses and that this helped them
focus on test taking skills needed to improve their scores as well as providing
them with more review and practice with test questions. One graduate indicated
that moving the testing time to an afternoon session was important to her

OT Program Review 2/24/2010

Seventy five percent of the respondents reported that they were very or
moderately comfortable with the new exam format. Twenty-five percent indicated
they were somewhat comfortable. None of the graduates reported being
unprepared for the exam format. All graduates reported they had adequate time
to take the exam, though two graduates reported that they had to learn to monitor
the time they took on each question.

Respondents reported that they spent from 8 to 35 hours per week studying for
the exam, with five of the 10 ten graduates who answered this question noting
that they spent on average approximately 20 to 25 hours per week of study.
Among the ten graduates who answered the question on how many months they
studied for the exam, five indicated two months and four indicted three months,
with one graduate reporting six months. This might be an area for additional
study since interviews with three graduates who failed (detailed later in this
report) suggests that students do not study for the exam during fieldwork
placements, or for at least a brief break period after completion of the fieldwork.

All 12 respondents to the survey reported they were currently employed in
occupational therapy. Two graduates are employed within a school setting, three
within acute care hospitals, one in a skilled nursing facility, two in
rehab/outpatient settings.

 In answer to the question, “How well prepared do you feel for your current
position?” seven (58%) felt prepared at the entry-level, four (33%) reported they
felt very well prepared, and one (8%) felt extremely well prepared for their current
position. When asked to identify the areas of practice for which they felt most
well prepared, graduates responded with a wide range of areas including
communication, evaluation, assessment and evaluation, acute care, postural
alignment, etc. It should be noted that interviews with three students who failed
the exam also confirmed that students felt adequately prepared to practice in
occupational therapy.

The areas that were report most frequently (reported more that one time) as
being well prepared for practice as a result of their SMU education were
communication and interpersonal skills, documentation, and generally knowledge
of disorders, diseases, and conditions. No areas were reported more than one
time as an area where the students reported being unprepared for practice with
the possible exception of “neuro” and “observing and treatment planning for
postural alignment” which were both noted once.

Results of the survey confirm results of previous alumni surveys in noting that
graduates feel that SMU prepares them at entry-level or better for their first OT
position. Employment sites for graduates continue to reflect the transitions noted
in OT as described earlier in this report, with hospitals, schools, and outpatient
rehab centers being the primary employers. Data on the students experience

OT Program Review 2/24/2010

with the NBCOT exam suggests that some students need more opportunity to
practice taking timed exams of the type used by NBCOT, and could benefit from
test-taking skill development.

    Analysis of Emails from Graduates Who Failed the Credentialing Exam
Six 2008 graduates who were not successful on the first attempt to pass the
credentialing exam contacted the Chair or a faculty member known to be an item
writer for NBCOT. Two graduates contacted the program to share the positive
news of their success on the exam. Messages from the graduates who initially
failed the exam indicated they were performing only slightly below the passing
level and were puzzled on how to improve their performance. Two reported they
took the Therapy Ed test preparation workshop and felt this had helped them
improve their test-taking skills. One student, who was the last in the cohort to
take the exam, wrote the following comment: “I wanted to let you know that
when I started my ortho rotation my supervisor reported that I had received a
better base of knowledge than any of the 16 previous students he had
ever instructed. My inpatient supervisor also stated that she was impressed with
the range of OT principles that I had been exposed to during school! I felt this
was a great nod to the education I had received at Samuel Merritt. So thank you
for preparing me for my future in OT!”

                 Interviews of Students Who Failed the Exam
Three graduates who failed the exam on the first attempt were interviewed to drill
down on the particular experience of this group and to assess whether those
graduates felt SMU prepared them adequately for the exam. Copies of the
interview transcripts are provided in the Appendix. Graduates are identified only
by number to provide anonymity. Without exception, the three grads indicated
they felt that SMU prepared them adequately for their careers in OT. All are
employed, are satisfied with their work, and feel that SMU prepared them for their
profession. The three graduates attributed different reasons for their difficulty
with the exam. Two grads indicated that test-taking skill were the primary issue in
their performance, one noting that she knew she was taking too long reading and
rereading test questions. This grad also experienced the death of one of her
best friends almost immediately after she completed her clinical rotations. This
delayed her study preparations and scheduling of the exam. The second grad
indicated she felt she knew the material but needed more direction on test taking
strategies to move her score from around 430 to the needed 450 to pass. The
third graduate indicated she erred in taking the exam in the early morning hours
when she felt groggy and not adequately alert. She had made an early morning
appointment in order to go with two other classmates to take the exam and
realized early on that she was very sleepy and almost withdrew at that time. She
passed the exam easily on the second attempt with little additional studying when
she scheduled it for an afternoon session.

None of these graduates reported difficulty with the new simulation portion of the
exam. Only one felt it might have been helpful to have some formal guidance for

OT Program Review 2/24/2010

test preparation while taking the fieldwork rotations. All reported that fieldwork
was challenging, involved very long days, and left them too exhausted to do
much formal study for the licensure exam. Two of the graduates were
particularly unenthusiastic about returning after fieldwork for review and test
preparation, noting they felt the need for a break. The third grad indicated she
would have been willing to return to school for more formal preparation if it would
be helpful in passing on the first attempt. However she also confirmed the level of
exhaustion and need for a break reported by the other grads interviewed.

One graduate recommended that the school could assist students by negotiating
with a commercial vendor to offer a test preparation course on site at more
reasonable cost and in closer proximity to SMU. The two grads who took a prep
course felt that the test taking strategies and timed test-taking practice were most
valuable in preparing for the certification exam. Given that all members of the
cohort have passed the credentialing exam, it appears that all were able to
develop a plan and mode of study that eventually worked for them individually in
passing the exam on a repeated attempt.

Survey results from this class, as well as interviews with three students shed
some light on the student experience with the NBCOT exam. Information on
students’ study patterns for the exam is less clear. Interviews clearly suggested
that students probably do not study specifically for the exam as a rule during their
fieldwork experience. In addition, graduates reported the need for a break
following completion of rotations which often occurs right around the Christmas
holiday period. Since NBCOT (and our own data) indicate students do better on
the exam when they take it within two months after graduation, just when do
students study for the exam? Is there only a brief window of opportunity for in-
depth test review and when is this period? This area warrants further exploration
to guide faculty action. In addition, this might be a good topic for faculty
collaborating in a research project with a few other OT programs.

The NBCOT Exam

                    Changes in the NBCOT Certification Exam
The National Board for Certification in Occupational Therapy, Inc. (NBCOT®) is a
not-for-profit credentialing agency that provides certification for the occupational
therapy profession. For some years, the NBCOT exam was a 4 hour computer-
based, two hundred item, multiple-choice exam using clinical scenarios for
evaluation of competency. The test plan is based on a job analysis of entry-level
therapists. Item writers are selected from a pool of occupational therapists that
are trained to write test questions which cover OT competencies. Development
of the OT credentialing test plan is a dynamic process with new questions and
testing methods being developed each year. In 2009, a new test format was
introduced, resulting in a new two-part exam. The first part included 170 multiple
choice questions and the second part a series of clinical simulation items. As

OT Program Review 2/24/2010

sometimes happens, this change resulted in a national average pass rate drop of
10 points, with some programs experiencing even more dramatic decline.

A phone discussion with Brenda Coppard, PhD, OTR, Chair of the Occupational
Therapy Department at Creighton University until July 2009, verified that
Creighton experienced a significant drop in first time pass rate in 2009. (The
Creighton website indicated a pass rate of approximately 60% for first time test
takers in 2009.) Similar to the experience at Samuel Merritt, students
subsequently passed the examination on a second or third attempt. The
program investigated and determined that no major change in curriculum or
policy change was warranted. However, to address the decline in test results
and to meet a new ACOTE accreditation requirement for entry level doctoral
programs, Creighton now requires students to pass a comprehensive,
standardized examination demonstrating competency in OT in order to graduate.
The exam costs $75.00 per student. It is Dr. Coppard’s sense that the new
testing requirement ensures that students make study and preparation for the
exam a high priority, and it provides them with additional experience in the test-
taking format used for the licensure exam. She reported that recent data
indicates that graduates of Creighton’s program have returned to previous levels
of performance.

Many other OT programs experienced a sudden and significant drop in pass
rates this year and expressed concerns about this to NBCOT. The credentialing
agency has not been very responsive to this concern to date. As a result of
dissatisfaction with the NBCOT response, the OT Program Directors Education
Council requested a formal exploration of this matter through its list serve group
in which 70% of list serves members supported seeking more information.

NBCOT staff did conduct some analysis of early test results and disseminated
findings at the April 2009 Program Directors meeting. They reported

      Early indicators were that there is a higher pass rate for candidates testing
       between 0-3 months from graduation (the last internship).
      The new inclusion of simulation problems did not impact failing
      Time management may be the biggest indicator of performance (passing
       candidates distributed time on the multiple choice questions evenly).
      Spending more time on the simulation problems (not rushing through) – an
       average of 12 minutes per problem instead of 10.2 minutes resulted in a
       higher pass rate.

Additionally, all program directors were informed that by the fall of 2009 a
customized score reporting service would be available for a fee. This would
allow SMU to look at cohort specific data, names of passing and failing students,
performance data across domains, and time use patterns across the
examination. Currently the department only receives the pass rate for the SMU

OT Program Review 2/24/2010

program as well as the national pass rate. The Chair of the Department has
contacted the NBCOT office and was told that the customized reports are not yet
available and that further details about the availability of the report would be
given at the October Director’s meeting in Baltimore. In spite of recent follow up
from the Chair of the OT program by email, there has been no further response
from NBCOT.

During the period 2003 through 2006, physical therapy experienced a similar
downturn in the performance of graduates across the country on the PT
credentialing exam. While passing scores of Samuel Merritt PT graduates were
not negatively affected, many schools were put on warning by the professional
accrediting association, the Commission on Accreditation of Physical Therapy
Education (CAPTE), because their graduates’ pass rate fell below 75% for first-
time test-takers. There was a period of lively tension between the accrediting
association, the schools, and the credentialing agency (The Federation of State
Boards of Physical Therapy) until performance results returned to historical levels
within approximately three years. As is the case currently with NBCOT, there was
never any acknowledgement by the credentialing agency that changes in the PT
exam blueprint, testing methodology, or methods of scoring were at play in the
downturn which occurred nationwide.

Although information from NBCOT has been limited, the OT department will use
the preliminary findings to guide its work with OT students in the future as they
prepare for the credentialing exam. It is clear, as reported by the NBCOT, that
time management is a large factor in success on the exam as well as the time
frame of when the exam is taken. These two factors will be discussed below with
an action plan.

                  Time Management During the Examination
As noted above, time management was found nationally to be the biggest
predictor of success on the NBCOT exam. Students who spent equal amounts
of time across questions and sections of the exam did better than students who
spent too much time on selected questions or any one section.

It is also known that if a student fails the exam on the first attempt, they are likely
to fail it on subsequent attempts. The reasons for this are both that the pool of
second time takers is made up of weaker students and that the questions are
often presented again from the pool of computerized test questions, making the
student question their first time answer. In addition, test anxiety increases with
each repeated attempt. In past years, when a student failed on the first try, and
did not work with a faculty member to revise their study and test-taking methods,
they frequently failed on the second attempt. What is surprising about the
current SMC scenario is that all of the class of 2009 has now passed the exam.
Some sought advice from SMU faculty members, some increased their study and
preparation, and a few took a commercial test preparation workshop.

OT Program Review 2/24/2010

                          Scheduling the NBCOT Exam
As noted above, the national data collected by NBCOT indicates that success
rate on the exam is significantly better when the exam is taken between 0 to 3
months from graduation (after the final fieldwork) with an even higher percent of
passing in 0 to 2 months. In analyzing data from the SMU class of 2009, eight
students took the exam between 1-1-09 and 3-15-09 within the first ten weeks
following completion of requirements. Of these, 100% of them passed the exam.
In the following months, 15 more students took the exam with only 5 students
passing (a 33% pass rate). Clearly students should be advised not to delay
taking the examination following graduation and a reasonable period of study.

                 Exam Preparation Within the OT Program
The SMU faculty has the second year students do the following in preparation for
the exam:

– Each student is required to take a mock NBCOT exam twice in the last
  semester of their didactic work. This mock exam is similar to the NBCOT
  exam but is compiled by a private company. The purpose of this mock exam
  is twofold: to give exposure to a 4 hour computerized exam and to instill a bit
  of anxiety in the students since they tend to not perform well on the exam at
  this point in the program. When this was first implemented, when our pass
  rate fell into the 70% level (2001-2003), it appeared to make a positive
  difference and we saw our scores improve greatly.
– Two faculty members who have been item writers for the exam, as well as the
  Chair of the program, all meet with the students for 1 hour before the end of
  the last on-campus semester. We review how to prepare for the exam, how
  to study, an overview of the exam format, and we let them know that if they
  do not study, they will not pass the exam.
– In the last year (this would not yet have been implemented for this recent test
  group). We also incorporated a three hour lecture on preparing for the
  NBCOT exam, given by Chi-Kwan Shea who has been an item writer for the
  NBCOT exam for many years and is quite knowledgeable on the test details.

Problem-Based Learning to Enhance Learning & Test Performance
The OT department recognizes that problem based learning is a strong
component to pulling together learned material, synthesizing it, and applying
critical reasoning to presented problems. Best practices in the field have
indicated that problem based learning is critical to a sound education. The
literature looking at sound research comparing Problem Based Learning to other
methods is minimal yet there is evidence that Problem Based Learning is an
effective method for teaching students complex processes and procedures such
as planning, communicating, problem solving, and decision making, although the
studies that demonstrate these findings do not include comparison groups taught
by competing methods.

OT Program Review 2/24/2010

Financial Performance of the OT Department
Data on the financial performance of the OT program is included in the
Appendices. A review of this data reveals that the OT department is making a
major contribution to the University over and above its direct educational
expenses, a contribution amounting to a projected net balance of $1,525,370 in
2009. The program margin is sufficient to warrant additional resources for the
program if needed to enhance preparation of students for the credentialing exam.

Future Plans for the OT Department
Earlier in this report it was noted that though there has been some discussion
over the years regarding the potential for offering an entry-level doctoral degree
in occupational therapy (OTD), unlike physical therapy, this degree has not been
widely embraced by the profession. It is unclear whether offering an OTD
program would create a special niche for SMU or whether the added educational
cost would further deplete an already modest applicant pool. Moving forward on
an OTD would require a careful market analysis. At present, there is simply no
compelling evidence that this is the direction to take.

There is a great interest within the MOT department to offer a post professional
doctoral degree, bit not an OTD, due to the problems surrounding this; currently
the OTD can be either an entry level doctoral degree or a post professional
degree. The interest of the department is to offer a post professional degree
along the lines of an EdD, DHSc, PhD or similar, but one that would allow for
many different students (not just OT students) and the possibility of other SMU
programs becoming involved. This is currently being explored.

Departmental Action Plan
The OT faculty initiated immediate corrective steps to ensure the next cohorts of
students are well prepared for the licensure exam. These action plans are well
underway. In addition, the consultant hired to assist with this program review,
has made recommendations that are in the section which follow.

Action Plan 1: A survey will be conducted of all the students in this testing
cohort (students that did and did not pass the exam the first time) to determine
what factors allowed them to become successful, what areas of concern they
had, the amount of time they applied to studying for the exam, when they sat for
the exam, and their perception of why they were successful on the 2 nd attempt if
they did not pass on the first attempt.

Action Plan 2: We will now be implementing a full day review in January
(following the two internships) on the SMU campus. This will be started with our
current students on internship and will be made a requirement of graduation.
This review will be much more comprehensive than the review they currently
receive and will be in addition to what we currently do. This comprehensive
review will be over 9 hours, held on a Saturday. The content of the review

OT Program Review 2/24/2010

course will be for students to take a four-hour mock exam similar to the NBCOT
exam with a review and rational of the answers, to review time management
related to the exam, and study strategies. Additionally, a sample study plan will
be covered with strategies for success.

Action Plan 3: During our mandatory review we will be emphasizing the data
regarding national testing success and when a student sits for the exam following
their last fieldwork. Students will be given a study plan with this time frame taken
into account. In future years we will give each class of students a plan for
studying when they complete their didactic work and review this again at the
January mandatory meeting.

Action Plan 4: Repeat the survey of first year students to assess whether there
is more balance in the amount of out of class study time required for kinesiology
and other core OT courses to determine if the proposed changes implemented
last year were effective.

Action Plan 5: Review and re-evaluate admissions requirements currently
required as well as explore any possible testing measures that would more
accurately predict the success of the students admitted into the program. Kate
will be working with John Garten-Shuman, Anne Seed, and Che Abram to
explore possibilities.

Action Plan 6: We have implemented an integrative seminar into our
Professional Development Seminar course with Problem Based learning as the
model. This was approved and implemented this past spring into an already
existing course. This did not increase the total units in our program.

Action Plan 7: To mimic the NBCOT exam, especially with the knowledge that
poor performers appeared to have poor time management, we have also
discussed in the OT faculty meeting the need for more of the exams to have time
limits to more closely approximate the NBCOT exam format. All faculty members
have been requested to add a limited time frame to their exams to simulate the
NBCOT exam. This suggestion was accepted by many of the faculty and will be
implemented immediately. We assume a longer period of time will be given to
essay and short answer tests as well as to first year exams verses the second
year. By the second year of the program, for all exams with multiple choice
questions, an hour will be allotted to each 50 questions. The NBCOT exam allots
4 hours for 200 questions

Action Plan 8: Explore the feasibility of offering a commercial test preparation
workshop at the end of the program, with emphasis on test taking skills and
individual diagnostic testing of areas of strength and weakness to provide
students with guidance for licensure exam preparation. (A joint workshop with
the two other OT programs in the region might be considered.)

OT Program Review 2/24/2010

Many of the steps in the action plan have already been initiated. Final
recommendations are also offered by the consultant on this review.

     1. The OT Program should be moved to watch status with monitoring of
        licensure results in 2010. A progress report should be required in 2011.
        Rationale: There is no evidence that there are serious problems in the
        curriculum, clinical fieldwork, or faculty complement. Changes in the
        licensure exam, along with the admission of a weaker cohort of
        students appear to be primary factors in the performance of the 2009
        cohort. Data collected during this program review indicate that weak
        test-taking skills, changes in the NBCOT exam, along with individual
        factors, resulted in a higher than expected number of first-time test-
        taker failure than has been experienced in recent years.

      2. Admission requirements should be reviewed and fine tuned with the
         use of a formal rubric for evaluating the writing sample and positive
         point weighting for pre-admission completion of anatomy and
         physiology, Rationale: The current writing sample is not
         systematically evaluated, nor is there evidence that assessment of this
         sample has been standardized. Evaluating a writing sample is
         however a good idea, given the importance of this skill in the program.
         Program selectivity can be increased by adding points for successful
         completion of anatomy and physiology before admission without risk of
         adding an admission requirement which might decrease the number of
         students in the applicant pool.

      3. Faculty might consider using a standardized academic skills exam on a
         trial basis to assess whether this is predictive of success on the
         licensure exam. The program could administer this during orientation
         and use for counseling purposes initially until sufficient data and
         analysis indicate whether this measure is predictive of success in the
         program and on the licensure exam. Rationale: Grade point
         averages, upon which the program relies as a major indicator of
         academic aptitude, have been affected by significant grade inflation
         and vary depending upon college or university of origin and number of
         science courses taken.

      4. Student preparation for the licensure examination should be
         strengthened in the future by:
          Stressing effective test taking strategies.
          Using timed examinations at intervals in the program
          Adopting exam formats similar to those used in the licensure exam
             and use these frequently throughout the program

OT Program Review 2/24/2010

            Counseling students about how to study for, and timing of taking
             the exam.

         Rationale: Communication from students and interviews with a sample
         of students, who failed the credentialing exam on the first attempt,
         indicate there is a need to strengthen student skills in test-taking.
         Additional study on how and when students prepare for the exam might
         be of benefit in developing future action plans.

      5. Build stronger faculty consensus and action on standards for
         professional behaviors among OT students, and promulgate these in
         departmental policy statements and course syllabi. Stress consistency
         in dealing with deviations from expected professional behaviors.
         Rationale: Interviews with faculty indicate that students may progress
         to final clinical rotations when behavior concerns become glaringly
         evident. It appears that expectations need to be reinforced more
         effectively throughout the program.

      6. The core faculty should review the performance of the entire cohort at
         the end of each level of the curriculum, developing action plans with
         students where needed to address academic concerns, clinical
         deficiencies, and professional comportment. Rationale: This is
         considered a best practice in graduate professional education. Annual
         review of an entire cohort is less likely to permit weak students to slip
         through the cracks.Early intervention may enhance performance at
         graduation and help avoid problems during final rotations.

      7. The faculty should explore the potential benefit of requiring a
         comprehensive final examination (at the end of coursework and prior to
         final fieldwork experiences) focusing on knowledge and skills which
         demonstrated students have met program outcomes and
         demonstrating readiness for success on the licensure exam. Faculty
         might consider setting a required performance level (acceptable
         passing score) to meet graduation requirement and to ensure student
         readiness for final clinical rotations. Rationale: Student performance
         and acquisition of knowledge and skill may be more than merely the
         sum of the parts (grades in OT courses). Furthermore, a comp exam
         might improve student study and preparation, an important
         consideration; given that students report they are too exhausted during
         fieldwork to engage in study for the credentialing exam.

      8. The department should set up a plan of action to assure that more of
         the fulltime faculty members are prepared at the doctoral level.
         Rationale: The department just meets the current standard set by the
         accreditation council of having at least 50% of fulltime faculty hold a
         doctoral degree. Thus the loss of a single doctoral prepared faculty

OT Program Review 2/24/2010

         member could put the program into non-compliance with accreditation
         standards. In addition, it is also an expectation that faculty teaching
         graduate education are prepared at the doctoral level. If the program
         moves forward with a post-professional doctoral degree in the near
         future, only those with a doctoral degree would be eligible to teach in
         this program.

      9. The Academic Vice President should convene a regular meeting of the
         fieldwork and clinical coordinators to share information about best
         practices in clinical education, to explore the feasibility of certification
         of preceptors and clinical educators, and to establish standards for
         supervision of students in undergraduate and entry-level graduate
         clinical programs. Rationale: Although an in-depth study of clinical
         fieldwork policies and practices was not the focus of this study,
         interviews with the clinical coordinators and support staff in OT,
         Nursing, and PA, indicates that there is no sharing of best practices in
         clinical education across disciplines at SMU and that there is great
         inconsistency in the level of supervision from campus faculty.
         Collaborative sharing of resources and best practices in policies and
         procedures could improve the quality of clinical education at SMU.

OT Program Review 2/24/2010

                                   Appendix I
                              Interview Transcripts

                  (Available in the MOT and IR departments)

OT Program Review 2/24/2010

                                Appendix II
                               Financial Data

                  (Available in the MOT and IR departments)


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