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African Journal of Health Professions Education

versión On-line ISSN 2078-5127

Afr. J. Health Prof. Educ. (Online) vol.13 no.3 Pretoria sep. 2021 



Moving fieldwork online: Innovations in an occupational therapy curriculum



L Hess-AprilI; M AlexanderII; S StirrupIII; A B KhanIV

IBSc (OTT), MPH, PhD; Occupational Therapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
IIBSc (OT); Occupational Therapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
IIIBSc (OT); Occupational Therapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
IVBSc (OT); Occupational Therapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa




Why was the idea necessary?

The occupational therapy (OT) programme at the University of the Western Cape endeavours to develop graduate competencies for critical practice that recognises how conditions of people's lives affect occupational participation.[1] The curriculum tenet of community development at the fourth-year level of study contributes to this development. The key focus of community development is to confront structural oppression within a specific community context.[2] Accordingly, Freire's[3] critical pedagogy is adopted to assist students to question and challenge beliefs and practices that dominate in communities.

Given that fieldwork allows students to immerse themselves in communities, students become critically aware of various social injustices prevalent in those communities. In building connections, students learn to work with communities to plan, implement and support relevant actions to promote health and well-being in the community at large. However, the rapid transition to online learning necessitated by the COVID-19 pandemic meant a shift to alternative forms of teaching outside the historical format.


What was tried?

Adopting a co-operative inquiry approach,[4] lecturers and supervisors utilised continuous joint reflections on teaching practice as a shared space to re-think learning and teaching practices. While students could not be physically present in the community, to guard their safety as well as that of community members, they were still expected to meet core competencies and attributes of being critically conscious. Online learning had to achieve what authentic and experiential learning would have. The challenge was to find ways of collaborating with communities and to create an enriching fieldwork learning experience within a virtual learning environment.

Cultivating a nurturing and enabling online learning environment and ensuring that students had a choice regarding when and how they engage in learning was imperative in being responsive to the call for decolonising health professions curricula.[5] While the university endeavoured to support students with data and devices, we were nonetheless aware of the difficulties students would experience. Some of the challenges that shifting to online learning posed include access to devices, data and connectivity. Lecturers and fieldwork supervisors needed to heed students' home contexts and psycho-emotional readiness in dealing with the changes forced upon them by the pandemic.

An adapted online community fieldwork module was devised and presented on the University of the Western Cape online learning management system iKamva. Sund's'61 suggestions for moving teaching online in the face of the COVID-19 crisis were useful in guiding a re-thinking of learning and teaching practices. Adopting a community of inquiry process, he premises that online learning occurs through three interconnected elements. The first element is social presence that concerns students' ability to identify and communicate with the learning community. For example, students joined small (tutorial) groups that were co-ordinated by their supervisors. Tutorials took place on iKamva, Zoom or Google Meet, and enabled students to interact with their peers, with interactions often continuing in student groups on WhatsApp after the completion of the tutorial. The second element, cognitive presence, concerns students' ability to develop knowledge and understanding of theoretical constructs, and apply this to a specific context. Students engaged with literature in the form of dedicated readings, formal input, breakaway group discussions and individual reflections. Scheduled discussion forums and class meetings on iKamva, Google Meet and/or Zoom at dedicated times further facilitated knowledge and application through lecturer- and student-led inputs, as well as through the submission of group tasks, individual essays and reflective journals. The third element of teaching presence encompasses both the overall design of the educational experience and the facilitation of learning, highlighting the role of lecturers and supervisors.

Table 1 provides an overview of the different learning and teaching strategies employed in relation to the different elements.



Two focus communities were selected, one urban and one rural. Each student worked with one of these communities as an online practice setting. Students could access previous project reports in the course resources folder on iKamva. Further information on their respective communities was to be accessed via the internet, e.g. YouTube. Over a 6-week period, students engaged in a process that commenced with community entry and analysis, through to intervention planning and implementation. Case scenarios were integrated into various tasks done in small tutorial groups or larger class meetings. These often resulted in vibrant discussions that continued among student groups outside online lectures.

A key dimension of the curriculum was collaboration with community stakeholders, who played a significant role in providing contextual information in order for students to compile community profiles. It was important that communities' voices were heard in order for the students to work with them in planning relevant interventions. Community members were invited to engage with the students on the virtual platforms in the form of dialogues, meetings, consultations and workshops. These activities were digitally recorded for the purpose of student video presentations, and learning portfolios were shared with supervisors, who provided feedback and facilitated critical analysis and evaluation of the community strategies, approaches and principles demonstrated.

For formative assessment purposes, students compiled digital graphic presentations and home videos in which they demonstrated interventions and specific skills by involving community members online as well as members of their households in role-plays and simulated activities while observing COVID-19 protocols. Students further chose the option of live online skills demonstrations on iKamva and/or Google Meet as an alternative to sit-down exams for summative assessments. Detailed guidelines were effective, as students appeared to engage in the examination sessions with minimal anxiety. Students presented the community process they followed with related evidence, demonstrated their skills through a compilation of the aforementioned home video clips, evaluated their own personal transformation and growth throughout the fieldwork module and engaged in discussions with examiners.


The lessons learnt

The COVID-19 pandemic provided an opportunity for lecturers to be creative concerning transferring learning materials online, and to increase their understanding of challenges that students experience regarding learning. Students who would generally not speak up in a class environment became more engaged as they received individual attention during one-to-one online meetings with supervisors. Uploading content such as videos, articles and presentations, as well as using platforms such as iKamva, are excellent ways to make content accessible. However, the key to online learning is utilising platforms in such a way that it is possible for students to engage fully. Lecturers and supervisors are responsible for creating opportunities for learning and interaction that stimulate exploration and thinking, while student-directed learning is reinforced in turn. Similarly, adaptability in how supervisors facilitate learning, as well as in understanding how students learn, are necessary skills for online learning to be successful.

In evaluating the module, students shared incidents of transformation and personal growth. They highlighted a process of personal development within the learning area of cultural competence even though the experience was online. They acknowledged that critical questions posed by supervisors exposed systemic injustices and personal privileges and preconceived ideas that they were unaware of, such as making assumptions about communities based on stereotypical views. This is evidence of how the online module, not unlike previous fieldwork experiences within communities, contributed to the development of graduate attributes.

One of the overarching lessons learnt through this process is that despite certain constraints, the transition to online learning and teaching was generally a positive experience for students and lecturers. The reciprocal relationship between supervisor and student was maintained. It must, however, be noted that community members reported that online learning did not allow for the relationship between the community and community developer (the student) to reach previous levels of depth, owing to limitations on the time spent with community members.

The experience emphasised the importance of institutional support. Lecturers and supervisors were careful to provide students with not just the necessary support to assist in coping with the demands of remote learning, but also the emotional demands of the COVID-19 pandemic. Ways in which lecturers demonstrated support was through being flexible regarding deadlines and forms of submission, and extending time allowed for completion of tasks and assignments. This, together with adopting innovative ways of teaching, however, proved to be more demanding than previously in terms of time and increased pressure on lecturers, also highlighting their need for support. Nonetheless, learning outcomes were achieved, in that examinations proved students to be generally competent in the knowledge and skills required to engage in community development practice.


What will we keep in our practice?

A variety of tools that catered to students' different learning styles was utilised within the online learning approach. The flexibility that accompanied the approach made room for renewed approachability by lecturers and supervisors, which allowed for optimal learning. Going forward, a blended learning approach will be adopted, where students' physical fieldwork learning experiences in communities will be complemented with online learning as an integral part of practice education and service learning. While the programme successfully moved to online learning and teaching, there were certain challenges related to connectivity and data-related constraints that caused some students to be inactive for some of the online learning activities. Should students continue to experience connectivity difficulties, printed material and provision of flash drives with learning content are one way in which this constraint will be addressed. In sustaining institutional support, the university should continue to explore ways in which support provided to students during the COVID pandemic and beyond could be provided to students on an ongoing basis in order to ensure that online learning is accessible to all students.

Declaration. None.

Acknowledgements. We wish to thank the students and community members who participated in the online fieldwork module.

Author contributions. LH-A lead the writing of the various drafts of the report, and edited and finalised the manuscript. All authors assisted with its conceptualisation and contributed to the final manuscript.

Funding. None.

Conflicts of interest. None.



1. Hammell KW, Iwama MK. Well-being and occupational rights: An imperative for critical occupational therapy Scand J Occup Ther 2012;19(5):385-394.        [ Links ]

2. Ife J. Human Rights from Below: Achieving Rights through Community Development. Port Melbourne: Cambridge University Press, 2010.         [ Links ]

3. Freire P. Pedagogy of the Oppressed. London: Penguin, 1990.         [ Links ]

4. Heron J. Co-operative Inquiry: Research into the Human Condition. London: Sage, 1996.         [ Links ]

5. Ramugondo E. Healing work: Intersections for decoloniality. World Fed Occup Ther Bull 2018;74(2):83-91.        [ Links ]

6. Sund KJ. Suggestions for moving teaching rapidly online in the face of the corona crisis. Working paper. Roskilde University, 2020. (accessed 8 February 2021).         [ Links ]



L Hess-April

Accepted 15 June 2021

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