Attitudes of occupational therapists toward continuing professional development

INTRODUCTION

Every professional is expected to perform their duties to uphold the highest possible standards of knowledge, skill, and attitude.^[1] Even “service users” or clients automatically assume that healthcare professionals are adequately trained.^[2] The high public trust and consumer confidence make healthcare professionals more accountable for the quality of service they provide. No single course of action can satisfy these needs and help maintain standards of practice, but continuing professional development (CPD) has long been one of the vital approaches considered to develop healthcare professionals ready to adapt to changes. However, a review of the literature revealed ambiguity and confusion regarding the definition and objectives of CPD. Various organizations have described CPD as either a form of lifelong learning for professionals, an approach to personal development, a way for professionals to ensure control and security in the workplace, a way to assure consumers of quality service, a means for professional associations to ensure that their professionals comply to their standards of practice or a means for employers to employ the most competent and up-to-date professionals.^[3] Several studies have also presented debates about whether to implement CPD mandatorily or voluntarily.^[4-10] Competency maintenance is the shared responsibility of the profession, individual professionals, professional organizations, CPD providers, regulatory bodies, and employer organizations. The macrocosm of healthcare provision, therefore, involves various stakeholders, making it difficult for professional organizations to decide to serve each stakeholder’s best interests in the issue of the requirement of CPD.^[4]

Occupational therapy (OT) is a growing profession and the World Federation of Occupational Therapists urges all OTs to accept and carry out the responsibility to participate in CPD to respond to the rapid changes within its realm.^[11] In line with this, the Philippines, which leads in producing competent professionals in various disciplines, enforced the “CPD Act of 2016” to adapt to the ever-changing demands within and among professions, maintain quality service delivery, and serve the public interest. In spite of the good intentions for CPD, this was filled with controversy as most Filipino professionals clamored against its mandatory implementation.^[12] The literature revealed that positive attitudes toward engagement in CPD activities dominate due to the perceived benefits OTs acquire from participation.^[5,13,14] However, several OTs choose not to participate in any CPD activity due to difficulties in completing the necessary number of CPD hours and a lack of financial resources. Some also perceive CPD as plainly revenue-raising or just another policy requiring compliance.^[15] Because CPD is expected of professionals, with or without the implementation of a law, it is important to determine the attitudes that they possess toward CPD, how these are rooted in one’s beliefs, and how these may influence one’s perception and behavior. Furthermore, the unique attitudes of Filipino OTs toward CPD may emerge, which could potentially bring about benefits and/or challenges toward their participation.

MATERIAL AND METHODS

RESULTS

A total of 105 out of 370 PAOT members (28.38%) responded to the ARAACES [Table 1]. Most participants were women (n = 77, 73.33%). Only a few (n = 5, 4.76%) have acquired a postgraduate degree. The majority (n = 52, 49.52%) have been working for <3 Years as an OT. Most participants (n = 65, 61.90%) work in National Capital Region (NCR) private clinics (n = 84, 80%). Most participants receive a monthly income between PhP 31,560–78,900 (n = 57, 54.29%), which comprises the middle-income class according to the 2012 family income and expenditure survey by the Philippine Statistics Authority.

Part two of the ARAAACES asked participants to identify the CPD activities that they engage. Most of the participants have experienced attending a workshop or seminar (n = 94, 89.52%) and conference (n = 87, 82.86%). The least frequently used CPD activities are mentoring (n = 11, 10.48%) and undergoing mentorship (n = 8, 7.62%). It can also be observed that none of the participants have written in journals as a form of CPD.

Part three of the ARAACES consisted of a nine-item Likert scale. It is important to note that the negatively worded items (items 3, 4, 7, and 8) have been reverse-coded before data analysis. In addition, a mean score of at least 4.0 pertains to a positive attitude toward CPD [Table 2]. Most of the OT participants (72.38%) exhibited positive attitudes toward CPD, and an overall mean score of 4.17 indicates on average, Filipino OTs exhibit positive attitudes toward CPD. There were no significant differences in attitudes toward CPD according to any of the personal (i.e., sex and educational attainment) and practice-related (i.e., years in practice, primary practice setting, geographical location, and monthly income) characteristics. For personal characteristics: (1) there was no significant difference between scores for males (M = 4.11, SD = 0.36) and females (M = 4.19, SD = 0.45); t (103) = −0.85, P = 0.4, and (2) there was no significant difference between scores for Bachelor’s degree holders (M = 4.16, SD = 0.43) and postgraduate degree holders (M = 4.42, SD = 0.36); t (103) = −1.34, p = 0.18. For practice-related characteristics: (1) there was no significant difference in attitudes of OTs toward CPD in terms of years in practice [Table 3] at P < 0.05 level (F [3, 101] = 2.3, P = 0.08); (2) there was no significant difference in scores among OTs from various practice settings [Table 4] at P < 0.05 level (F [3, 101] = 0.84, P = 0.48); (3) there was no significant difference in scores among OTs working in NCR, Luzon, Visayas, and Mindanao [Table 5] at P < 0.05 level (F [3, 101] = 1.49, P = 0.22); and (4) there was no significant difference in scores among OTs of various monthly income [Table 6] at P < 0.05 level (F [3, 101] = 0.57, P = 0.64). This may have resulted from a small sample size and a large difference in number between groups as observed from the demographic profile.

DISCUSSION

Occupational therapy is a female dominated profession across most, if not all, countries, even reaching a heaping 91% of practitioners in 2017.^[22] In the Philippines, a survey in 2018 showed that three out of four OTs are females.^[23] These statistics explain why the majority of the sample in this study is composed of female participants. Most participants work in NCR, which is one of the most urbanized areas in the Philippines. The trend is similar with most countries as well due to perceived better benefits and opportunities in these cities. A previous study also showed that 50% of OTs practice in NCR while the remaining 50% are dispersed across the remaining 16 regions.^[24] However, in the present study, most of the participants work in private clinics as compared to US statistics, which indicate that around 40% of OTs work in hospitals and schools while only 14% work in outpatient clinics and early intervention.^[25] The system largely differs such that OT is covered by insurance in most developed countries. In developing countries, patients who need OTs spend on their own and must find private clinics offering OT, which is the reason for larger staff recruitment in private clinics. The average monthly income of the majority of the participants is between PhP 15,780 and PhP 78,900, which indicates that they are in the lower middle to middle-income brackets. This is comparable to the survey results during the 2017 Annual Convention held by PAOT, which showed that the median monthly income of OTs is PhP 50,000.^[23] The majority of the participants participate in workshop seminars and conferences. This trend is also very similar to a scoping review across research done in OT between 1995 and 2015.^[9] For doctors, they think that they learn best through experience.^[26] Formal programs are still perceived to have a greater impact than voluntary and informal CPD activities.^[5] As gathered from the FGD and online interviews, OTs prefer attending workshop seminars due to the benefits, namely, personal development and improved quality of service. The all-in-one feature of a workshop makes it worthwhile such that OTs feel that its interactive nature improves both their knowledge and skills compared to other CPD activities that only seem to target the theoretical aspect. Conferences are also well-supported because for the participants, CPD is a way to keep themselves updated with trends and practices in OT. Half of the participants participate in in-service training and online learning. The perceived benefits of CPD participation, such as gaining knowledge and skills and learning from others during formal CPD activities, make them more appealing to Filipino OTs.

OTs choose CPD activities by considering the relevance of its content to their practice and interest, apart from the pragmatic considerations of cost and accessibility. These are similar factors considered by nurses and doctors.^[26,27] In another study, the researchers have identified intrinsic (i.e., self-motivation and personal satisfaction) and extrinsic (i.e., promotion, financial increase, reimbursement, and certification requirements) motivations toward CPD.^[28] Being in a service-oriented profession, aside from improving themselves, they feel that CPD helps fulfill their societal responsibility to enhance the quality of service to be provided to their consumers or clients. This is in accordance with Amerih’s study^[4], which enumerated seeking professional knowledge, increasing the status of one’s profession, updating existing qualifications, and improving individual competence as internal reasons of OTs for CPD participation. The CPD cycle based on Kolb’s learning cycle illustrates how professionals engage in CPD.^[29] Professionals identify their learning needs through reflection on current skills and desired outcomes. They select which CPD activities to take and participate in those which they think will meet their learning needs. However, it was revealed by both quantitative and qualitative data that OTs usually participate in formal CPD activities and rarely in informal ones. This may be due to a narrow concept of CPD or a lack of availability of various CPD activities.

CONCLUSION

Formal CPD activities are still preferred over informal CPD activities due to the perceived benefits of each type of CPD activity on personal development and quality of service and the lack of awareness of informal CPD activities. After a cost-benefit analysis, OTs select CPD activities with return on investment as the overarching factor.

Filipino OTs possess positive attitudes toward CPD due to the perceived benefits of CPD participation, but personal priorities may discourage some from taking them. The perception that CPD is an investment may compete with other expenses and commitments such that one may avoid participating in them if there is no guarantee of a return.

There were no significant differences in attitudes toward CPD according to any of the personal (i.e., sex and educational attainment) and practice-related (i.e., years in practice, primary practice setting, geographical location, and monthly income) characteristics. However, groups of OTs from Mindanao and OTs working in home healthcare exhibited negative attitudes toward CPD. These may be attributed to child rearing, motivation toward learning, accessibility, cost, and personal prioritization. Furthermore, all stakeholders must understand and be aware of the responsibility of professionals to improve themselves and the rights of the clients to receive the best quality of service.

Filipino OTs prefer formal CPD activities to informal CPD activities. Therefore, formal CPD activities such as workshop seminars and conferences must be maximized by incorporating learning activities that will improve both knowledge and skills by making CPD more interactive and collaborative and through a well-informed implementation. Experts in health professions education may be tapped to create programs based on sound theory and current evidence, with an understanding of how knowledge is constructed and how it can be best applied to professional practice.

On the other hand, informal CPD activities such as consultation with peers, mentoring, and journal writing must be marketed some more to increase the participation of OTs. The advantages of ease of conduct, increased frequency, convenience, and reflection make informal CPD activities appealing. However, confusion regarding the awarding of CPD units and documentation guidelines hinder OTs from engaging in informal CPD activities. The Professional Regulation Commission (PRC) and PAOT must work together to create more comprehensive implementation guidelines with more encompassing assessment methods. The professionals must review the importance and benefits of various informal CPD activities.

Filipino OTs possess positive attitudes toward CPD. These positive attitudes, especially enjoyment of learning activities, must be utilized to facilitate CPD participation . An in-depth needs assessment must be conducted to identify what OTs want to learn and currently need in practice to provide meaningful CPD activities that meet these needs and allow OTs to apply what they have learned into practice easily. CPD providers need to be sensitive to OTs’ learning needs and be innovative in creating programs to fit these needs. Emerging areas of practice in OT must also be studied. More evidence and research will establish new areas of practice with which various CPD activities may be created and offered to OTs. In addition, PAOT and PRC must exercise their roles to evaluate quality CPD activities to be provided to their professionals to ensure that the programs offered can be applied to practice and thus develop the profession and improve the service provided.

CPD operational guidelines in OT can be made more inclusive of OT subgroups. Females may need to take time off CPD-related activities when bearing and taking care of a child. The CPD regulatory requirements may be difficult to comply with during this period. A certain number may decrease the number of required CPD units once a female OT gives birth within the 3-year renewal period.

Advocacy for CPD must be done by developing a positive attitude toward learning even for as young as undergraduates. This is to ensure that the love for learning and the sense of curiosity are instilled in the students and that these are maintained through their years in practice as professionals. There will always be innovations, paradigms, and skills within the profession. Failure to keep up-to-date may lead to a decay in professional knowledge and expertise and consequently to inefficient or, worse, unsafe practice. Therefore, OTs working in the academe should always include attitudinal goals whenever they are teaching. Instructional methods for the intentional teaching of attitudes must fit adult learners and the current healthcare context.

Increasing the accessibility to quality CPD activities of all OTs from the various islands of the Philippines working in various practice settings will improve the overall state of the profession and healthcare in the long term. CPD providers should consider the results of an in-depth needs assessment to create programs that will fit the learning needs of most professionals. Moreover, other alternative options include a weekend or evening schedule of programs, actual work settings as a venue for CPD, and online provision of learning activities.

Employers are recommended to share the responsibility of CPD with professionals. Incentives or an increase in salary on receiving certifications or attending seminars may be provided to encourage CPD participation and accessibility. Increased funding for CPD, employee benefits like paid leaves, encouragement through memos, and adaptation of a CPD framework on planning, implementation, assessment, and documentation of CPD supported by employers are some ways to facilitate CPD in the workplace. Improved dissemination and promotion of CPD programs within the organization will also enhance CPD participation.

Individual OT professionals are expected to be responsible and proactive regarding their CPD. They should do their best to maximize their learning experiences to increase the return on investment in CPD. They must also accept the trend of pursuing multiple careers to open new job opportunities and roles to further the benefits and return of investment in CPD. Increasing the number of OT graduates and improving the regulation of OT practice will create competition that will increase the standards of practice.

Future researches are recommended to include all Filipino OTs, even those who are non-members of PAOT, to generate a larger and more representative sample. Even other professionals in another field may replicate this study as CPD is also expected of them. The perspectives of other stakeholders must also be discussed to have a more comprehensive understanding of CPD in the Philippines. It is interesting to identify the perceived effectiveness of specific CPD activities to aid in the creation of effective programs for learners, achievement of learner goals, and improved patient outcomes. An in-depth needs assessment must also be done to facilitate CPD planning and implementation.