Cynthia S. Bell

UNC Board of Governors 2018 Teaching Award Winner Cynthia Bell

Winston-Salem State University

Teaching Philosophy

There are many influences that have shaped who I am as a teacher and even more that have impacted me as the person I am today. For the purpose of this portrayal of my teaching philosophy I will focus on how an occupation-based model has impacted my teaching and mentoring of occupational therapy students. By the end of this document and through reading the letters of support and peer evaluations, readers will get a feel for the strategies I employ to incorporate WSSU’s values of Student-Centeredness; Excellence; Stewardship; Integrity; Social Justice; and Trust in my approach to teaching. Readers will also understand my intentional approach to address the WSSU Strategic Plan’s goal 2: Enhance Quality of Graduate Education, and specific OT Departmental goals under this particular university goal:

1. OT Department will provide transformative academic experiences for graduate student education through teaching and community engagement

1e. Faculty will infuse technology tools for teaching and course delivery (i.e. EMR, eportfolios, etc.); and

3. OT Department will foster collaborative partnerships to promote professional and community service, leadership and research

3f. Faculty and staff will engage in ongoing professional and/or community service

3g. Foster student leadership in state, national and international organizations

4. OT Department will build interprofessional (IP) learning opportunities with undergraduate and graduate programs

4b. Facilitate integration of IP learning activities across disciplines

Being an Occupational Therapist

As a master’s degree trained occupational therapist, my work with students began when I took on the role as the Clinical Coordinator for Occupational Therapy Students at Moses Cone Hospital. While working with students directly and mentoring clinicians who took on students themselves I realized I wanted to contribute to the continuing growth of my profession by pursuing a career in academia. I began at WSSU in 1998 as an Assistant Professor and the Academic Fieldwork Coordinator (AFWC). In 2001 I furthered my education in occupational therapy by starting a PhD program with a focus in occupational therapy. In 2004, I returned to clinical practice full-time while working on my dissertation, but found I missed the challenge and stimulation of academia and was fortunate enough to return to WSSU’s OT program in 2005 again as the AFWC/Assistant Professor. I completed my PhD in 2006 and wanted to use more of my knowledge and skills gained during my doctorate. In 2011, I moved into a more direct teaching position within the OT department.

Occupation-Based model

This background is significant because through my doctoral coursework I not only gained further in-depth knowledge about occupational-based theories and models, but I also took a course on educational pedagogy. That course was pivotal for me to gain additional confidence as an educator. One of my assignments involved taking an occupation-based theoretical model and applying it to teaching in some way. To this day, I am still building on that assignment as I write this narrative. The WSSU MSOT curriculum is embedded with an occupation-based model called the Person-Environment-Occupation (PEO) model (Law et al., 1996) and therefore this C. Bell Portfolio for BOG Award has a heavy influence on how I teach and work with students. Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between a person, his or her occupations and roles, and the environments in which he or she live, go to school, work and play. I will go into more depth to describe the various components of the PEO model and provide support materials in the appendices of this portfolio.

Person

The person is a unique being who assumes multiple roles and cannot be separated from contextual influences. The person brings to the context a set of attributes, skills, knowledge and experience. For me, I try to get to know the “person” in each of my students. I try to understand what motivates and drives them as well as what life experiences they have encountered. I work hard for each of them to know their experiences can bring significant contributions to our class discussions. It is also extremely important that each student feels comfortable in my classroom. By comfortable, I mean willing to be himself or herself and actively participate regardless of their confidence in their knowledge on a topic. There are two ways I would like to highlight that I utilize to begin getting to know each of them as a student and an individual. The first is an assignment prior to the New OT student orientation. This assignment asks students to complete the Index of Learning Style (ILS) (Felder & Soloman, 1988). The ILS has been used by the OT program for about ten years and was selected because of the research supporting the instrument as well as the descriptive articles available to educate students on their learning preferences. Students post their individual learning profiles from their results of the ILS inventory on a google doc, which then becomes a class composite that is shared with the cohort and faculty. These composites are documents I refer to frequently while planning my teaching so I can appeal to students’ learning preferences. This ILS assignment is posted through the Cohort Blackboard portal, which I also developed to try to build a cohort or class community before they ever even come to campus. The MSOT Cohort Blackboard portal (2016-2018, 2017-2019) initially provides an online orientation for campus wide and MSOT departmental information, but then serves as a depository or resource center for each cohort. This portal remains a communication center for announcements and forms that is available for all OT faculty and the cohort throughout their time as a student.

The second way I get to know the students early on is through inviting them to share who they are. This assignment was traditionally due on the first day of the OCC 5303: Analysis of Occupation course. Typically, I post an announcement on the Blackboard course or send an email to the class asking each student to bring three items or artifacts that are meaningful to him/her or represent who they are as an occupational being. We then begin class by getting in a large circle and sharing a comment or two about the objects. For many, it reminds them of the nostalgia of “show and tell” but I have had some students who share very personal feats like being a cancer survivor, or share a piece of jewelry from a parent who passed away, or a photograph of a pet. This year due to the success of the “Get to know you” activity and past comments from students, we moved this activity to our new student orientation. All faculty and even several second year students participated. The activity took over an hour, but served as a meaningful exchange which set the tone for our expectations of them as a person and student in the program and as a member of the OT family. Many of the incoming students offered positive C. Bell Portfolio for BOG Award feedback to continue this meaningful activity on their “New Student Orientation surveys”. Therefore this will continue as a tradition for our new student orientation sessions.

Environment

The second component of the PEO model is environment. Environment is the context within which occupational performance takes. Occupational performance results from interactions between the person and the environments in which he or she carries out tasks and roles (Law et al., 1997). The environment represents the “physical-sensory-socio-cultural phenomenon within which occupational performance occurs” (Chapparo & Ranka, 1997). As described in these models, the environments consist of internal and external factors that must be considered as student’s occupational roles are developed. I see many opportunities that I can facilitate learning by paying attention to the environment, both internal and external. Internal environment is composed of “structures, conditions and influences that are found within the curriculum” (Chapparo & Ranka, 1997, p. 5). These include educational activities, instructional strategies, curriculum objectives and resources. Within the internal environment student knowledge, skills, values and attitudes are considered. Integration of these components culminates in students’ performance of roles. For our curriculum, we have designated those roles as practitioner, educator/learner, researcher and administrator. Each of our courses emphasizes development of at least one of these roles and sometimes more than one. In my teaching strategies, I intentionally plan active and reflective learning segments to reinforce learning of material and I use a variety of instructional methods such as, inquiry learning, case study, interactive lecture, didactic laboratory experiences and group work. One of these methods featured on my videos is the 5-minute recall exercise used at the start of class throughout the semester. This exercise asks students to brainstorm topics covered so far in the course. Initially they are not to use their notes or each other, however they can write the topics down. Then I ask for volunteers to share their topics and either they describe them or I go into a brief description. This allows content covered at the beginning of the course to stay fresh in students’ minds as well as allow them to make connections with how the earlier content connects to current topics. Students have continually commented on course evaluations that this 5-minute recall activity was beneficial and should be continued.

The external environment is composed of structures, conditions and influences that surround educational activities and tasks (Chapparo & Ranka, 1997). In terms of my teaching, I see this as preparing students to assume their occupational role, it is necessary to consider the immediate and long-term practice environments. The climate of healthcare is ever changing, therefore, I feel compelled to try to keep a pulse on what are the current best practices, professional issues regionally, nationally and internationally. My involvement at a national level with the AOTA Volunteer Leadership Development Committee, keeps me well connected and in the know of professional issues. It also allows me to model active professional engagement for our students which supports the OT Departmental Strategic Plan goals of 3-3f and 3g as stated in my opening paragraph. My networking on a national level has kept me abreast of various opportunities to invite our MSOT students to get involved at a National level. Recently, I was able to nominate one of our MSOT students, Leah Pelletier, for the AOTA Emerging Leaders Development Program. This is a very competitive program of applicants from all across the United States. Leah was selected and participated in the initial workshop last in August 2017 and C. Bell Portfolio for BOG Award immediately posted this with a photograph to Facebook “I’m still wrapping my mind around the past few days at AOTA’s Emerging Leaders Development Program. So inspired, self-aware, and motivated to embrace this next year and honored to have met so many excellent leaders and emerging leaders (pictured in a photo with current AOTA President Amy Lamb and Vice President Shawn Phipps).

As a clinician working with elderly, I determined I needed to gain all of the knowledge and skills I could with the escalating numbers of elderly living with dementia. Becoming certified as a dementia training in 2012 and then recertifying in 2016. In spring of 2017 my work bringing a dementia course to our OT students also brought recognition to WSSU as the Crisis Prevention Institute (CPI): Dementia Capable Program designated WSSU as a Dementia Capable Society Leader. The WSSU website did a feature article on the students that received their dementia capable care provider certificates and the story was posted on the UNC system website in May, 2017. My advanced certification in dementia allows me a unique opportunity to share how that condition is crossing all arenas of practice and led me to develop a special topic course focused on dementia. In this course, students learn about the different forms of dementia, how to best work with individuals with dementia and their caregivers, and then get an opportunity to go out into the community to work with individuals with dementia, engage in reflection after each visit to a related reflection discussion board prompt, and then integrate concepts and materials learned in the course in a final case study assignment. Once student have completed the CPI workbook they are eligible to take an additional exam through the CPI Dementia Care Specialist organization to gain a Dementia Care Specialist certificate. Again, student feedback supports continuing and even expanding this offering. A goal of mine is to see an interdisciplinary certificate offering in the area of dementia.

The healthcare practice arena and current healthcare climate demands efficiency. I would like to address the external influence areas of interprofessional teamwork and technology. Effective practice includes working as part of an interprofessional team. In recent years, interprofessional education (IPE) experiences have been mandated by the occupational therapy educational accreditation standards. Recent research Endorsed by the World Health Organization (WHO), IPE refers to educational activities where students from two or more health professions are engaged in shared learning (WHO, 2010). The goal of IPE is to prepare health professions students for deliberately working together with the ultimate aim of building a safe, patient centered health care environment (Interprofessional Education Collaborative, 2011). As stated in the opening section, the OT department has a strategic initiative related to interprofessional education. Specifically the goals state: 4) OT Department will build interprofessional (IP) learning opportunities with undergraduate and graduate programs and sub goal 4b. Facilitate integration of IP learning activities across disciplines. The OT and PT department have several experiences designed to build upon team collaboration. Faculty must intentionally structure shared learning experiences to promote IPE. The structured shared learning process enables students to acquire knowledge, skills and professional attitudes which help them comprehend the complexities of working in a multiprofessional environment (Horsburgh, R. Lamdin & E. Williamson, 2001). In an effort to develop additional IPE in my courses, last spring Dr. Leslie Allison from PT and I began developing a new IPE assignment into our fall courses. We assigned small groups of OT and PT students to collaborate on developing short self-care or mobility based video clips. Those videos were then watched together and the groups further collaborated on responses regarding what functional level (FIM) was depicted on the videos. Our post experience evaluation methods included a faculty debriefing session and post-experience student feedback survey. OT student feedback was extremely positive in regards to feeling more confident in assessing patients function according to the FIM criteria and continuing this as an IPE experience was definitely supported in the comments. Here is a sampling of what was shared “Definitely do it again! It was great being able to collaborate and think through scenarios with the PTs. I liked how each group gave their own rationale as to why they chose the FIM score that they did. I also liked the use of TopHat for the other groups to participate”, and “I appreciated that after each video there was a brief discussion if everyone wasn't on board. It helped to understand the FIM more when we discussed it after each video. I know it made the session longer, but that is when I learned the most from it.” I am excited that the intended learning objectives were achieved and students perceived the value of the assignment as well as the group process undertaken to achieve the objectives.

Technology is changing the delivery of healthcare in today’s society. This is one of the reasons the OT department included Goal 1) OT Department will provide transformative academic experiences for graduate student education and sub goal 1e. Faculty will infuse technology tools for teaching and course delivery (i.e. EMR, e-portfolios, etc.) in our strategic priorities. I will detail a few of the types of technology I use in my instruction. Electronic health records (EHR) are federally mandated, more health consumers have access to the internet, smartphones and tablets which supports the integration of using these devices into patient interventions. I have implemented electronic health records software, called Fusion Web first into my courses and now into the OT department as other faculty build assignments using the electronic health record. I worked with our Academic Fieldwork Coordinator who used the software for a student during her level II community placement, and the student wrote-up her evaluations, progress notes and discharge summaries. In spring of 2016, I was awarded a PDC grant to research integrating our OT departmental iPads into a couple of my courses. The study involved pre and post survey of students in my OCC 6313 and 5309 courses. The funding was used to buy a charging cabinet for the eleven iPads, cases with Bluetooth keyboards and to support the buying of apps for use in the classroom and in therapeutic interventions. Since many health facilities are using point of service documentation on tablets, I felt it was important to equip our students to work effectively with the iPads the OT department had purchased. In the OCC 6313: OT Interventions-Adult course students are paired and then have ten minutes to find a free app on the iPad that could be used to support an individual who survived a traumatic brain injury (TBI). The students then have to do a “quick pitch” about the app and why it is appropriate for use with the TBI population. Students have found apps addressing problemsolving, sequencing, perceptual and visual issues, etc.. Additional technology assists me in the class management and grading. I have used an app based quiz grading software called ZipGrade that provides instant scoring using my cell phone or tablet and immediate test analysis. Students appreciate the timeliness of knowing their quiz grades before leaving class that day. Most recently, this fall OT students have subscribed to TopHat student engagement software. This technology allows me to take attendance by having student’s text a randomly presented four digit code, as well as allows me to present questions for formative and summative evaluation in a variety of student response formats. My use of technology in the classroom lead to an invitation to present at the 2018 American Occupational Therapy Association’s annual conference on a panel for Education Special Interest Section titled “Beyond Clickers and Flipped Classrooms: Innovative Technology in Occupational Therapy Education”.

The above IPE and technology example demonstrates how I continue to expand technology and interprofessional collaborative experiences to meet the OT departmental goals (1.1e, 4.4b) and work toward WSSU Goal 2: Enhance the quality of graduate education by incorporating current external environmental factors into my teaching.

Occupation

The last component of the PEO model is occupation. The term is not simply related to work or employment, but is actually related to how individuals “occupy” their time. Another way to describe occupation is self-directed and meaningful tasks or activities engaged in throughout a lifespan (Law et al, 1996). Occupations are engaged in to satisfy an intrinsic need for selfmaintenance, expression, and life satisfaction and they are carried out within multiple contexts in fulfillment of developmentally appropriate roles. One of the specific occupations included in the Occupational Therapy Practice Framework (AOTA, 2014), which delineates the domain and process of the profession, is participating in formal education. The description given states “Participating in academic (e.g., math, reading, degree coursework), nonacademic (e.g. recess, lunchroom, hallway), extracurricular (e.g., sports, band, cheerleading, dances), and vocational (prevocational and vocational) educational activities” (AOTA, 2014, p S21). Another listed occupation is employment interest and pursuits and the description with it states “Identifying and selecting work opportunities based on assets, limitations, likes, and dislikes relative to work (AOTA, 2014, adapted from Mosey, 1996, p. 342)”. I include both of these because I feel the utmost duty to the profession to address the formal educational aspect, including the extra-curricular aspects of my students education in order to fully prepare them for employment and know what type of role or practice setting within occupational therapy they may be interested in pursuing. I feel I do this very intentionally in a number of ways. One is in class by sharing my experiences as a clinician in every class session I teach. Another way is by modeling my volunteer leadership within the profession and working with the student leaders to realize their potential if they are interested in pursuing leadership roles. Kylie O’Connell Sleeth who was the WSSU Assembly of Student Delegate for the AOTA and we had several discussions about her interest in serving the profession in a more formal way. She ran and was elected as the national Vice-Chair for the Assembly of Student Delegates. She graduated several years ago, but has continued her leadership path with state level involvement. I connected her at an AOTA Leadership networking reception with several members integral to the AOTA Emerging Leaders Development Program, and the next time she applied she was accepted.

A more recent example involves a current MSOT student, Michael Pegg, who served as a graduate research student with me during the 2015-2016 academic year. His project was a joint project between National Ambucs (a service organization, national headquarters are in High Point, NC) and WSSU OT program. I serve as a research advisor to the AMBUCS Amtryke board. The amtryke is a therapeutic tricycle that AMBUCS Chapters fundraise and give away to individuals with special needs. This project involved modifying a previously used survey aimed at gathering perspectives from parents and riders about the experience of using an amtryke. The survey was deployed last spring and we wrote up an executive summary. The project was so well received by the national office they invited us to present at their annual conference, expenses paid in Tucson, AZ. Unfortunately I could not attend, but worked with Michael to groom him for his presentation, which was October, 2016. Not only did he present, but he assisted with a conference events like the veteran’s ride and the amtryke rodeo (a tricycle give-a-way event), and he was the only student representative at the conference.

Yet another way I mentor my student’s occupational endeavors is through my student research projects in the courses OCC 5212: Conducting Occupation-based Research and OCC 6215: Research Writing and Dissemination. As a program, I feel it is extremely important to engage in occupation-based research that students will find meaningful and that will contribute to their understanding and skill development. As a qualitative researcher, many of my student projects tend to be qualitative in nature or involve mixed methods. Some of the titles from past projects are: Quality of Life and Health Perceptions of Recently Displaced Residents of an Assisted Living Facility (2016); Adaptive Nintendo® Wii™: Experiences of Adults with Orthoneurological Disorders in Assisted Living (2015); Quality of Life and Health Perceptions of Adults with Physical Disabilities Living in an Assisted Living Facility (2014); The Physical, Social, And Emotional Impact of the Use of a Therapeutic Tricycle on Children: Parents’ Perspectives (2013, 2017); The Effects of Nintendo™ Wii on Quality of Life, Social Relationships and Confidence to Prevent Falls (2010). Each one of these projects involved students gaining a better understanding of others as occupational beings, sometimes it involved the use of interview instruments, sometimes activities like playing the Nintendo Wii with elderly or with severely physically disabled which then meant students also had to learn about how to handle someone with severe spasticity or dysarthric speech. I am proud that each one of my student research projects has a lasting impact on the students.

PEO as a Curriculum Model

There is more significance to the PEO model and that is the MSOT curriculum is based upon this model. I already mentioned the roles that are identified and tied to specific courses. However, there are additional ways in which the program weaves the PEO model throughout our curriculum. Three years ago, we had a consultant come who worked with us on a curriculum review. The outcome after 2 days was that we were all satisfied with our curriculum and our curriculum model, however, it was not especially explicit throughout our program content. We identified some specific tasks to work toward making the PEO more evident to students. A graphic representation of our version of the PEO model was developed. One of my tasks was to develop an assignment to teach first year OT students about the curriculum model. I do this in the OCC 5303: Analysis of Occupation course. It is a natural fit as all semester, students are learning to analyze various aspects of occupation from cooking, outings to crafts. This particular assignment is the feature of the other video on the USB drive. The assignment I developed involves assigning pre-work to students ahead of time. The various components of the curriculum model graphic are assigned to students so that each small group has 1-2 students assigned to a component part. Students gather as much information about the component he or she was assigned and brings notes to class. Students also read 2 articles on the PEO model. One article is about the model and another is a series of case studies using the PEO model. During class, the students get into their groups and each group has cut-out components of the model to organize on a poster. They collaborate on how to best describe the components on the poster. Once the posters are complete, a representative from the group presents the poster to the entire class. Then I follow with a brief lecture to solidify the key points.

The graphic model is threaded throughout courses in the remaining semesters. For example, I have incorporated a cover sheet where students have to respond to the PEO components for cases in the OCC 5309: Movement Components of Occupation as well as the OCC 6313: Occupational Therapy Adult Practice courses.

Conclusion and Additional Supporting Materials

I have presented my teaching philosophy using the PEO model. By doing so, I feel students experience the model themselves throughout the curriculum and can then gain personal experience with it and how it applies to occupational therapy practice. Additional support materials for my effectiveness at using this model and addressing students as occupational beings include a Midterm Assessment Plan (MAP-done through CETL), and mid-term feedback solicited on my own, Peer and Chair evaluations and letter from a co-instructor, and Advising Evaluations, Advising evaluations and additional letters of support for my nomination from current students (2016 and 2017). It is my hope that the evidence I provided herein supports my efforts to contribute in numerous ways to WSSU’s and OT’s strategic goals to “enhance graduate education” and provide transformative education to our students.

References

American Occupational Therapy Association (AOTA).(2014).Occupational therapy practice framework: Domain and process (3rd ed.).

American Journal of Occupational Therapy, 68(Suppl.1), S1– S48.http://dx.doi.org/10.5014/ajot.2014.682006

Chapparo, C., & Ranka, J. (1997). Occupational performance model (Australia) Definition. Monograph 1: OP Network: The University of Sydney-Australia. Felder, R. &

Soloman, B, (1988). Learning and Teaching Styles in Engineering Education, Engr. Education, 78(7), 674-681.

Horsburgh, M., Lamdin, R., & Williamson, E. (2001). Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning. Medical Education, 35(9), 876-883.

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L. (1996). The Person-Environment- Occupational Model: A transactive approach to occupational performance. CJOT 63(1), 9- 23.

World Health Organization Definition of Interprofessional Education. WHO Study Group on Interprofessional Education and Collaborative Practice, 2010. Retrieved from World Wide Web https://en.wikipedia.org/wiki/Interprofessional_education.

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