Building Professional Identity Through Scholarly Activities Insights from OTD Students

BUILDING PROFESSIONAL IDENTITY THROUGH SCHOLARLY ACTIVITIES:

INSIGHTS FROM OTD STUDENTS

Introduction

Professional identity formation (PIF) plays a pivotal role in professional education,

fostering not only a shared purpose but also a cohesive professional identity (PI) among its

community of members (Ashby et al., 2016; Wenger, 1998). The PIF is a socialization process

where members build a deeper connection and sense of sense self within a professional field

through continuous interactions and experiences (Schell & Gillen, 2019). Professional education

serves as a rite of passage for aspiring students to acquire the essential knowledge and skills for

practice, deepen their understanding of their future role expectations, and earn membership

linked with a professional status and identity (Adams et al., 2006).

As students elect to enter into a professional education program, they begin a

transformative process heavily influenced by the learning environment to develop a new identity

but also a transformational experience for students to gain a greater sense of self within one’s

emerging professional role and identity (Schell & Gillen, 2019). By understanding the

significance of PIF in developing a PI, educational institutions can ensure a well-rounded

approach to prepare students for future roles as leaders, scholars, and practitioners (Heeb et al.,

2020; Krishnagiri et al., 2019; Mitcham, 2014).

The PI of a profession and its community of professionals (e.g., nurse, teacher, and

medical doctor) reflect the collective behaviors, attitudes, and expectations externally shaped by

the societal and historical context (Mak et al., 2022; Merton, 1960). Further, PIF involves

internalizing the unique beliefs, values, and ways of being and doing distinctive to each

profession (Barradell, 2022). This merging of internal elements (e.g., motive and perception of

self) with external factors (e.g., standards and sociocultural dynamics) makes the PIF process

complex and leads to a diverse understanding of how PI is defined and developed by

professional communities.

Despite the varying perspectives on PI and its formation, professions can acknowledge

how these concepts help maintain workforce effectiveness and readiness. Thus, a solid

professional identity cannot exist without a deep-seated PIF weaving of professional philosophy

(the warp) and professional values, beliefs, and principles (the weft) (Wood, 1995).

PIF and PI are not new concepts recognized in healthcare as it has provided a platform

for professionals to demonstrate their unique contributions and distinctiveness to stakeholders

and broader society (Merton, 1960; Stets & Burke, 2022). Extensive research has linked strong

professional identity, quality of healthcare services, and client outcome but primarily in the fields

of medicine and nursing health professions (Cornett et al., 2022; Mak et al., 2022; Snell et al.,

2020). Many healthcare professions, including OT, acknowledge the central role developing PI

to ensure to support growth and relevance in a competitive healthcare environment. Although it

is widely agreed that building strong PIs is crucial across various professions, the differences in

profession-specific roles, responsibilities, and culture make it difficult to establish a clear

understanding of these concepts. The lack of consensus in defining these concepts results in a

wide range of interpretations on how to promote PI development, which primarily begins during

the professional education and training phase. Therefore, it is important to evaluate and assess

how educational institutions are developing future professional identities.

This study aims to increase knowledge on the PIF process of OTD, specifically in

scholarly aspects where knowledge is limited. The capstone study strived to answer the question

of: "How do learning activities related to research and scholarly writing influence the

development of identity as a scholarly professional in OTD students?"

Statement of Problem

The concept PI and the process of PIF were initially explored in sociology and

psychology literature as a means to represent one’s distinctive image or contribution to society

(Becker & Carper, 1956; Cruess et., 2014). However, these concepts were associated with the

term occupational identification that recognized the significant relationship between a personal

and professional identity, giving meaning to things we are doing (Christiansen, 1999; Hitch,

2017). Early literature regarding the two phenomena revolved around how individuals would

associate their identities to what they did for work to earn a living. This initial understanding

empowered future research on forging stronger PI’s, emphasizing the formation process.

The early concept of occupational identification eventually evolved into PI, which refers

to how one defines oneself with a professional position or title, while PIF is the process of

integrating oneself to the role or responsibilities of the professional group (Becker & Carper,

1956). Establishing a strong PI connection with a set of core principles ensures a collective

ideology of the profession is articulated in practice. More notably, reinforces the professions

value, purpose, and distinct contribution to society (Bayerl et al., 2018; Best et al., 2019). For

this reason, professions began investing in the process of forming ideal workforces through

various approaches, specifically effective organizational socialization (Schein, 1968) and

professional socialization (Snell et al., 2020) strategies, to shape the thinking, acting, and feeling

of the group (Cruess et al., 2014). Supporting this process enables professions to cultivate

members who mirror and steer the mission, vision, and future of the organization.

Within the context of healthcare, PI reinforces the value, impact, and responsibility of

each health profession to contribution to improving client health and meeting the societal needs

in the field health (Snell et al., 2020; WHO, 2006). From this understanding, several health

professions such as pharmacy (Noble et al., 2014), physical therapy (PT) (Black et al., 2010),

and medicine (Crump et al., 2019; Sharpless et al., 2015) have investigated the mechanisms

influencing PIF. Acknowledging the need to generate strong PI’s and value in a complex ever-

evolving healthcare landscape, efforts to improve PIF have been prioritized toward education

and professional preparation.

Significance of Study

Occupational therapy recognizes the value of occupations, such as being a student to become

a professional, as it necessary to do, belong, and experience as occupational beings (Hitch, 2017;

2018). Participation and engagement in meaningful occupations contributes to our identity and life

satisfaction (American Occupational Therapy Association [AOTA], 2020). Understanding the

significant role of identity is essential for OT practice and an important concept for role transitioning

associated with new expectations, responsibilities, and overall growth (Christiansen, 1999). The

gradual progression from student to a clinician is a crucial process filled with opportunities for

acquiring knowledge and skills to become licensed OTs (Roberts et al., 2022). This process contains

education, training, and clinical experiences that are essential to PIF, creating a new sense of self

within the field (Heeb et al., 2020; Hooper et al., 2020).

Building a clearer understanding of what academic activities, experiences, and overall

educative strategies that help facilitate PIF can enhance the professions commitment to support and

prepare occupation-centered graduates entering the fast-changing healthcare system (Fortune, 2000;

Hooper et al., 2015; Hooper et al., 2020; Pierce, 2001). Equally, recognizing the impactful

teaching and learning strategies within OTD curriculum will validate best practices necessary

for instilling scholarship, scholarly practices, and scholarly professional identities

(Accreditation Council for Occupational Therapy Education [ACOTE], 2018; AOTA, 2022;

Case-Smith et. al., 2014).

Promoting scholarship and shaping future scholarly professionals secures the professions

unique role within healthcare (AOTA, 2022). Scholarship practices not only stimulated the

growth of the profession, but mandated through OTD education accrediting bodies (ACOTE,

2018; Case-Smith et. al., 2014). Entry-level OTD graduates must be prepared and expected to

reduce the research to practice gap by implementing evidence-based practice (EBP) and

delivering high quality interventions as scholarly professionals (Landon et al., 2020). Despite

this favorable goal of advancing the PI of the profession, graduates cannot achieve this scholarly

identity alone and requires the disciplines community of scholars, educators, and education

systems to guide and prioritize this process.

Definitions

Learning Activities

Conceptual Definition: A range of carefully designed academic instructional tasks and

materials (e.g., assignments, projects, papers) to facilitate the acquisition and integration

of new knowledge that reflect the course’s objectives and outcomes (AOTA, 2021).

Operational Definition: Activities related to research and scholarly writing described by

OTD students and identified by AOTA (2021) as essential components of OTD education

for cultivating research competencies and proficiency in scholarly writing

Profession Identity

Conceptual Definition: A form of identity an individual perceives, compares, and

differentiates from other professional groups, which comprises of the specific practices,

values, ethics within a profession (Adams et al., 2006).

Operational Definition: The OTD student’s description of perceived alignment with the

profession’s values, skills, principles, and practices as a future practitioner through focus

group discussions.

Professional Identity Formation

Conceptual Definition: A complex process influenced by many factors in developing

and understanding one's role while internalizing the values, beliefs, and standards within

a chosen profession (Schell & Gillen, 2019).

Operational Definition: The OTD student’s description of becoming an OT practitioner

and constructing a professional self-image and sense of self that integrates personal and

professional values and behaviors (Adams et al., 2006). This process of becoming more

aligned with professional core values will be assessed through focus group discussions.

Scholarly Identity

Conceptual Definition: How an individual perceives themselves as a contributing

member to their profession-specific body of knowledge (Culpepper et al., 2020)

Operational Definition: An OTD student describes how they develop their scholarly

aspects of professional identity through scholarly learning activities identified by AOTA

(2021) in focus group discussions.

Scholarly Professional Identity Formation

Conceptual Definition: The individual’s process of integrating evidence-informed

practices into their professional roles and identity, embodying the skills, knowledge,

standards of a scholarly professional (Hayes et al., 2021).

Operational Definition: The OTD student’s description of developing a professional

identity as a scholarly professional with attributes identified by AOTA (2021) and

Fergusson et al. (2019) in focus group discussions.

Literature Review

The literature review investigates the existing literature surrounding professional identity

and influencing a scholarly professional identity amongst OTD students. This section begins by

examining identity and adult learning theories to build a foundation for understanding the flow

of the PIF process. The following section will examine contextual and environmental factors in

OT education and their influence on the OTD students’ developmental journey to form new

professional identities (i.e., occupational therapists). Next, the literature review will examine the

challenges and barriers, supportive influences, and areas of opportunity related to OTD students

and their development of PI. Finally, a literature synthesis will discuss the process of developing

PI and scholarly attributes in OTD students, identify the various influences, and highlight a

current gap in knowledge.

The Flow and Theory Behind Identity Formation and Learning

Healthcare professionals (e.g., OTs, PTs, and MDs) significantly shape their fields and

impact on society through their distinct contributions, driven by PI. Professions serve as

social structures where members share a common purpose and identity influenced by the

collective values crucial for developing a strong PI and community belonging (Freidson,

1984; Wenger, 1998). This section explores theories such as Identity Theory, Social Identity

Theory, and Communities of Practice to help understand PI, PIF, and the potential role

learning activities contributing to PIF. Research on PI and PIF is extensive and evolving,

offering unique insight across professions beyond the scope of this paper. Despite PI’s

complexity, health professions acknowledge the impact of PI on practice, member well-being,

and client outcomes (Ong et al., 2019). Therefore, this overview aims to present foundational

literature regarding PI with a particular focus on its development (PIF) to address the research

question.

Theories of Identity

Identity theory rooted in symbolic interactionism, suggests that individuals’ identities

are constructed by the roles they hold within their social structures (e.g., healthcare provider,

parent, student) (Stets & Burke, 2022; Stryker, 1968). This theory emphasizes the importance

of internal processes (e.g., fulfilling expectations) and shaping self-concept, where each role

is associated with distinct identities and meanings that influence behavior in specific contexts.

Identity Theory underscores that each role carries a unique set of expectations, standards, and

norms, which guide behavior and impact an individual’s self-concept. When individuals

strongly identify with the values of their roles (salience), they prioritize the role’s

responsibilities (prominence), and strengthen their connection to these roles. This alignment

leads to satisfaction (verification) and deepens their dedication (commitment) to the role. The

development of salience, prominence, and commitment is a dynamic process, fluctuating with

experiences and external feedback, such as social interactions and recognition.

Ong et al. (2019) explore the PIF process of clinician educators (CEs) in a qualitative

study using interviews and focus groups conducted in Singapore. The researchers examined

the experiences of balancing dual roles as clinician and educators of 23 OTs and 16 physical

therapists. Through an Identity Theory lens, the findings highlight the complexities in CE PIF

process, including challenges such as maintaining work-life balance, navigating competing

workplace demands, and experiencing lack of support and recognition. These factors often led

CEs to feel a misalignment between their professional roles. The findings revealed that

training experiences, leveraging peer support systems (e.g., role models), and fostering

collaborative work cultures were enabling factors for CEs when navigating their roles. In

academic context, these findings suggest that training experiences (i.e., learning activities) are

crucial in building relevance (salience), coherence (prominence), and confidence in role

responsibilities from application (commitment) (Stets & Burke, 2022). Additionally, the study

reinforces the significant role of the organizational culture and support in CE identity

formation, underscoring a general lack of awareness in organizations about this complex

process. This understanding of the organizational influence on PIF aligns with the principles

of Social Identity Theory, which emphasizes the significance of group affiliations, dynamics,

and behaviors.

Social Identity Theory is grounded in cognitive psychology and social psychology,

emphasizing the relationship identity development and group memberships (Tajfel & Turner,

1986). The collective self-concept is derived from social affiliations, such as the AOTA,

where individuals internalize the norms, beliefs, and characteristics of the group as part of

one’s self-concept. This theory of Identity emphasizes the influence of the group identity on

the individual’s PI that they are part of. This theory focuses on how the groups we belong to

contribute to PI through the norms, values, and overall culture shared within the group (Tajfel

& Turner, 1986). Moreover, this theory sheds light on the concept of mobility, which

recognizes how social structures can facilitate or inhibit the movement of individuals who can

join or move aways from group. This notion is foundational for understanding things like

social injustices, statuses, and transitions. This group-centric lens is crucial for offering

insight into academic communities (e.g., educators and students) and how their collective

values (i.e., research and scholarly writing) may influence their members, adding a layer of

understanding beyond the individual.

Devery et al. (2018) examined the effects of working in an Australian OT emerging

area of practice, eating disorders. The researcher employed a mixed methods sequential

design using surveys and semi-structured interviews to explore the relationship between

burnout, PI, and job satisfaction of ten female OTs working in eating disorder units, which

equates to half the workforce working in this specialty at the time of the study. Interestingly,

the findings indicated a significant correlation between higher exhaustion levels and stronger

PI among therapists, contradicting the purpose of this proposed study. However, through the

Social Identity Theory lens, this correlation can be explained by high levels of stress and

pressure to adhere to group norms (Tajfel & Turner, 1986). Although this this theory does not

explicitly address overly strong PI, it can be implied that the demanding roles and low sense

of belonging would make member mobility much more appealing when an opportunity arises.

Some limitations to the study are questionable sample size to generalize findings despite

rationale for specialty area. Additionally, the findings could benefit from further discussion

and explanation of this unique finding, along with grounding the research using a theoretical

framework. Despite the limitations, the findings offer insight into potential down fall of

strong PI, highlighting challenges of burnout and role difficulties. The findings also support

the need for supportive environments (i.e., supervision), which enabled a participant to

recognize value of OT roots in the face of challenges.

Lave and Wenger ‘s (1991) concept of Communities of Practice (CoPs) brings

Identity Theory and Social Identity Theory together by illustrating how the two theories can

come together in action to form an identity and PI. CoPs emphasizes a strong connection

between group membership and identity that gives meaning to the individuals actions (i.e.,

participation). While Identity and Social Identity theory offer insight into role-based and

group-based identity formation, CoPs adds the dynamic and participatory aspects of this

process (Stets & Burke, 2022; Tajfel & Turner, 1986).

The CoPs framework emphasizes the becoming and belonging in communities such as a

professional field (e.g., AOTA) where members learn and grow from the interactions and

activities (Wenger, 1998). Lave and Wenger (1991) suggest that learning and identity are

inseparatable processes that occur in CoPs, which are significantly driven by the community and

its context. Additionally, members enter a community as newcomers and progressively

development with increased participation and interaction. The researchers note CoPs are

individually unique, offering different knowledge, experiences, and challenges. This

understanding can suggest that learning, identity, and participation are essential to not only the

development of its members but the level of engagement, influencing the community’s overall

health and longevity.

Chen et al. (2017) offers insight into a program initiative, based CoPs, to facilitate PIF in

educational roles (i.e., clinician educators) at the University of California San Francisco (UCSF)

through a program development study design (Wenger, 1998). The Health Professions Education

(HPE) Pathway served as a platform to support professional growth, mentorship roles, and

essential health professional practices (e.g., reflection and scholarship). The researchers provided

a comprehensive description of the strategies to employ CoPs principles, curriculum’s design,

and explicit emphasis on PIF throughout the program. The findings support the development of

PI using CoPs framework. Some limitations of the study are lack of discussion regarding

limitations to the study’s findings, ethical considerations, and transparency to understand the

researchers position within the research. Despite the limitations, the findings suggest application

of CoPs can be beneficial in developing PI and engagement in scholarly activities such as

research and scholarly writing.

Taken together, the identity theories explained a logical progression for understanding

the development of identity, PI, and PIF. By first looking at the individual aspect, Identity

Theory begins with the main character or the professional who is the core of the PI (Stets &

Burke, 2022). The individual and their actions are driven by the roles that the individual elects to

have and perform, shaping their PI through the experiences of those choices. Thus, identity

theory lays the groundwork for understanding identity at the individual level, emphasizing

personal agency and responsibility, to expand into broader perspectives. After establishing the

individual perspective, Social Identity Theory expands into social contextual influences of

identity (Tajfel & Turner, 1986). This shift focuses on how the group environment and dynamic

influence the individual’s PI along with the behaviors, engagements, and self-concept. Lave and

Wenger ‘s (1991) CoPs framework brings both individual and social aspects together to

highlight the interactions and experiences shared by the members. CoPs underscore how learning

and growing professionally through participation and collaboration actively shapes PI.

Therefore, CoPs are dynamic living systems where interaction and participation are necessary for

the development of PI and survival of the community.

Identity theory and social identity theory provide a framework for understanding the

importance and process of forming an identity within CoPs. While identity theory offers insight

into the role and expectations within groups, social identity theory emphasizes the importance of

group membership (i.e., belonging). Thus, understanding both theories is crucial to grasp as it

intersects and interacts to form CoPs. Together, these theories highlight the inseparatable nature

of learning and growing together to shape identity within and beyond the group or profession.

Adult Learning Theories

Within OT education, institutions and educators are tasked to prepared students to

become future leaders, scholars, and practitioners through a multitude of teaching and

learning strategies (Heeb et al., 2020; Krishnagiri et al., 2019; Mitcham, 2014).Understanding

adult learning and underlying principles is imperative to develop curricula that promote

optimal learning. Two learning theories are referenced and considered essential when

acquiring knowledge in occupation-centered education (Ghul et al., 2013; Hooper et al., 2018;

Krishnagiri et al., 2017; Price et al., 2017). As a theory driven profession, it is important to

integrate adult learning theories in OT education as it enhances the students learning

experience, retention of knowledge, and development of a professional identity. Although

ACOTE will set the standards in OT education, institutions are not restricted by the teaching

and learning methods used for education (AOTA, 2022). However, curriculum frameworks,

education strategies, and academic position papers can be found in literature.

Adult learning in North America was introduced as andragogy by Malcom Knowles

(1978) to differentiate the process of adult learning from child learning, pedagogy (Merriam &

Baumgartner, 2020). Knowles's andragogy principles is commonly referenced in OT education

to guide and enhance the OT student learning process (Braveman, 2016; Russell, 2006).

Knowles' andragogy theory emphasizes the importance of understanding and considering the

characteristics, motivations, and experiences of adult learners to promote tailored learning

experiences. Adult learning is optimized when there is learner autonomy, integration of past

experiences, and applicability for future growth. The assessment of adult learning experiences

can be effective tools to gauge how they are orienting and perceiving themselves in the material

can help ensure learning is meaningful and engaging. In essence, adults require a level of self-

directed learning that enables the integration of current knowledge with new relevant ideas and

information to enhance the learning experience and outcomes. Educators can facilitate

intentional knowledge transfer by leveraging these principles to deliver engaging learning

experiences and opportunities.

Feldhacker and Greiner (2022) evaluate the effectiveness of an OT course redesigned

using active learning and andragogical principles combined with Fink’s (2013) taxonomy of

learning in a mixed methods explanatory sequential design study. The 15-week OTD

redesigned course incorporated interactive activities (e.g. think-pair-share), self-directed

learning, and Fink’s (2013) framework that was offered in a blended learning format (i.e., in-

person and online) where 116 students participated. The initial quantitative phase consisted of

a pre- and post-survey with end-of-course evaluations, which was followed by a qualitative

component involving focus group discussions to capture student experiences. The findings

showed a statistically significant improvements according to pre- and post-survey results and

positive remarks from focus groups, demonstrating effectiveness of active learning and adult

learning principles in the courses design. Additionally, findings suggest real-world application

learning was an essential component the participants learning. Some limitations noted by the

researchers were the limited generalizability of findings due to narrowed population of one

cohort at one OTD program and potential risk of response bias with direct faculty/researcher

relationship with participants. Despite limitations, the findings offer valuable insight into

student experiences regarding designing courses grounded in adult learning theories principles

in a blended learning format, which the researchers noted to be one the first within the study’s

contexts. The researchers offer insight into OTD student experiences and essential teaching

and learning strategies to enhance adult learning. Self-directed learning, theory with practical

application, active learning with critical thinking, and CoPs through online platforms (i.e.,

social media) are all crucial aspect of research and scholarly practice.

Another common theory cited in OT education is Jack Mezirow's (2002) notion of

transformative learning, which holds a process-focused view on the learning that involves a shift

in perspective (Merriam & Baumgartner, 2020). Transformative learning occurs in situations that

challenge the learner’s current beliefs and triggers a realization. This sudden disruption causes a

deep reflection and then results in a new understanding and worldview. This learning process is

essential as students acquire knowledge, practice reflective, and integrate new knowledge into

their beliefs, transforming their mindset in being and doing.

Fortune et al. (2019) examined the effects of an international project-based learning

(PrBL) internship using a Students-as-Partners (SaP) approach on the development of global

citizenship and intercultural competence of OT students. The qualitative research study involved

21 final year Australian OT students who volunteered for to participate in a 10-week internship

in Vietnam where they provided healthcare assistance as their capstone experience. The

researchers utilized focus groups and surveys to capture the perspectives of students and

community partners regarding the program. Based on five returned surveys and a focus group of

13 participants, the findings indicate that the culturally immersive experience challenged

students to adapt, collaborate, and develop new ways of practice to successfully navigate the

unfamiliar environment. While the findings showed a positive influence and transformative

learning potential for students, the researchers aim was to provide a comprehensive description

of the program and context to account for some of the limitations, such as a small sample and

unequal representation of participants. Despite the study’s shortcomings, international capstone

experiences appear to be an effective strategy to develop cultural and professional skills

essential

for OT practice. These valuable skills can shape professional identity, contributing to the

student’s ability to be flexible and adaptable in unfamiliar environments. The findings support

authentic and challenging yet supportive learning experiences in educational preparation for

students to become competent clinicians for clients from diverse backgrounds. Challenging

learning opportunities hold transformative potential as it allows students reflect on classroom

knowledge to apply in different situations, which are important aspects of experiential learning

theory illustrated next.

Experiential learning by David Kolb is another relevant learning theory OT education,

which that can be applied to all learners and describes the learning process elicited by hands-on

experiences (Merriam & Baumgartner, 2020). Although sharing the importance of reflection

with transformational theory, experimental learning occurs in continuous cycles starting with an

experience, prompting reflection to build new understanding, and then applying increased

understanding or skills to prior task that starts the process over (i.e., repetition and practice).

The cyclic process emphasizes learning by doing where each experience builds on current skills

and knowledge for application in other situations or contexts.

Kemp et al. (2022) builds on Fortune et al.’s (2019) understanding on transformative

learning and its relationship with experiential learning by delving deeper into the impact of the

doctoral capstone component for recent OTD graduates from three institutions. The researchers

highlight the gap in understanding on the impact of the capstone component from a student

perspective, forming the purpose of the descriptive study design utilizing virtual focus groups to

capture the perceptions of 21 participants. The findings indicate an overall positive influence on

professional development and readiness regarding the doctoral capstone component. The study

suggests that the doctoral capstone increased employment marketability and opportunities for

graduates as it provides a competitive edge, leveraging advanced knowledge and skills in

research to promote evidence-based practice. However, the researchers noted the potential bias

in a self-selected convenience sampling method and the use of graduates to facilitate focus

groups by excluding potential participants with negative experiences and risk of confirmation

bias from researcher involvement. Despite the limitations, the study provides insight into the

student perspectives on the advantages and challenges of the capstone component. The study

underscores the ongoing need to support and prepare student learning due to the lack of clarity of

the role of the capstone component, which is directly influences to the development of the

professional identity of OTD students, encompassing the expectations and responsibilities.

Inadequate support can lead to challenging capstone experiences, which are designed to develop

future practitioners in scholarly roles and practices.

Taken Together, andragogy, transformative, and experiential learning theories provide a

framework for understanding adult learning and also essential principles utilized in OT

curriculum design (AOTA, 2021, Feldhacker & Greiner, 2022; Fortune et al., 2019; Kemp et al.,

2022). OTD students Andragogy emphasizes self-directed learning with opportunities for

learners to construct and apply their experiences with new knowledge relevant for practice.

Drawing on these concepts to enhance learning encourages adult learners to transform their

understanding and worldview through critical evaluation of current beliefs. Adult learners will

engage in reflective practice to develop a deeper connection to new knowledge that can be

applied to real-world experiences, furthering their understanding by doing.

These principles serve as crucial ingredients for enhancing the adult learning when

embedded in professional education and training as it equips new members with the values,

beliefs, and standards for practice of a profession. This process directly facilitate and influence

the development of a professional identity of new members, which is the underlying premise

and outcome of professional education that bridges the gap between professional identity and

adult learning in preparation for practice (Hooper et al., 2020). Although the professional

identity formation process is continuous throughout practice, professional education can be

instrumentally powerful in fostering sophisticated members who reflect the ideals of a

profession and reinforce its relevance and value to society. Therefore, it is essential to have a

foundational understandings of adult learning principles to ensure new members effectively

acquire the necessary skills and knowledge to become competent professionals to support the

growth of the profession. Attaining legitimacy and sustaining professional status has been a

long transformative journey for field of OT especially when ensuring effective preparation of

adult learners in OT education.

Occupational Therapy Education

The educational process encompassing the teaching and learning strategies is without

doubt instrumental components of becoming an occupational therapist. Equally, the institution

and learning environment also play a significant role in this developmental process. Institutions

must maintain compliance with ACOTE standards for adequate preparation of OT students

(ACOTE, 2020). Understanding the organizational structures and governing bodies will help

draw the link between the development of PI in graduates and their social environments (Stryker,

1968; Tajfel & Turner, 1986; Wenger, 1998). Therefore, an understanding of the OTD

educational context will be explored before diving specific learning activities supporting

professional socialization.

The OTD Pathway

Around the early 2000’s, the emergence of the entry-level doctorate in occupational

therapy (OTD) became a relevant and necessary topic for discussion in OT education shortly

after the passing of Resolution J, which moved the profession to a post-baccalaureate degree

(Brown et al., 2015). This decision made by ACOTE aligned with the profession’s goals of

producing future clinicians who could effectively respond to the complex demands of healthcare.

Nearly a decade later, the AOTA governing body announces an updated vision to enhance

practice and quality of services by considering the transition to a single, entry-level doctorate

level degree (OTD) as entry into the profession (Smallfield et al., 2019). The vision was to

develop sophisticated graduates who are competing with other healthcare professions that have

adopted clinical doctorates (e.g., physical therapy, medicine, and pharmacy) (Case-Smith et al.,

2014). Despite the transition potentially benefiting OT services, concerns regarding readiness,

empirical support, and accessibility into the profession have been voiced against this mandate.

The OTD mandate aimed to ensure OT graduates garner advanced knowledge and skills

in leadership, advocacy, and scholarship necessary for responding to healthcare needs (Ozelie et

al., 2020; Smallfield & Wood, 2019). However, concerns regarding the lack of evidence,

readiness, and overall communication within the professional community generated little to no

support to promote this mandate for making a transition (Brown et al., 2015b; Ozelie et al.,

2020; Smallfield & Wood, 2019). Previous mandate attempts for transitioning into an entry-level

OTD appear to fall short in fostering a collective vision, which elicits little incentive to produce

the research or strategic planning for uncovering the potential benefits. The AOTA and ACOTE

governing bodies are responsible for the guidance and support of its members while ensuring the

profession maintains its relevance and responsiveness consistent with healthcare trends

(ACOTE, 2018; AOTA, 2020c).

Occupation-Centered Education

The rising complexity of healthcare combined with societal influences has brought

significant attention on the education and training of aspiring OT practitioners. A large amount

of research has been generated throughout the professions development, consisting of

refinement of education standards for practice and exploration of effective teaching and

learning strategies to prepare OT students. Throughout the vast amount of research

surrounding OT education best, the profession recognizes the need to ensure students develop a

deep value and understanding of occupation and should be integrated into educational content

(Krishnagiri et al., 2017). However, a study by Krishnagiri et al. (2017) surveying 25 U.S. OT

programs identifies underdeveloped strategies to center occupation within curricula to ensure

course material is linked the profession’s core philosophy. The findings indicate inconsistency of

approaches that explicitly centralize occupation across education programs for students to learn

and see how occupation promotes health. Additionally, the researchers note a continuing

challenge of effectively teaching OT taxonomy and proper use of terminology (e.g., occupation

and purposeful activities), which directly impacts the profession’s need for clear and consistent

communication and unified vision across all platforms (e.g., research and workplace).

Occupation-centered education is a framework developed to support educational

practices to enhance the learners understanding of the fundamental ideas of the profession

through six principles grounded in adult learning theories (Hooper et al., 2020). This framework

fosters a comprehensive learning experience by tailoring education to the student’s needs,

promoting practical experiences, and connecting all learning back to professional practices

rooted in OT. Additionally, this subject-centered approach not only encourages students to link

learned knowledge to OT concepts but also develop essential lifelong learning skills, such as

reflective practice.

Using an occupation-centered education approach ensures learning content aligned with

the profession’s core philosophies while fostering active learning experiences (doing) and

reflection (Hooper et al., 2020). Through reflection, students begin to critically assess knowledge

and experiences of occupations as a therapeutic tool, developing their occupational perspective

and lens (Lee Bunting, 2023). An occupational perspective is an essential skill for practitioners

to view and understand human doing as it relates to occupation (Njelesani et al., 2014). This

perspective enables the integration of the profession’s core philosophies into practice,

reinforcing an occupation-centered approach and professional identity. As students deepen their

understanding and value of occupations for human life, they can embrace an occupational

perspective to apply this understanding in their learning experiences and contexts. Thus, it is

essential to ensure students are engaging in occupation-centered learning and doing in their

educational and training environments to cultivate graduates the profession and society needs

them to be and become.

Scholarly Learning Activities

Occupational therapy practitioners recognize the importance of research, EBPs, and

continued advancement but may not have the capacity and access to do so in their practice

settings (Landon et al., 2020). However, OTD have the ability to mitigate this gap in research-

to- practice gap and lack of access to EBP knowledge. OTD students require plenty of

opportunities to learn, practice, and build the necessary abilities to bridge this existing gap of

research- informed practice.

Smallfield et al. (2019) conducted a survey study to explore the perceptions of MSOT

and OTD graduates from one institution regarding their post-education experiences and

professional outcomes. The research findings indicate that OTD students were more likely to

become educators, implement EBPs, and perform scholarly activities. Conversely, MSOT

students were more interested in clinical practice and express less interest in pursuing an OTD

due to a perceived lack of benefits. Both groups of participants reported the cost of obtaining an

OTD degree as a disadvantage where there were no significant differences between career titles,

pay, or perceived preparedness. However, the findings regarding the entry-level OT degrees are

limited to one academic program, which may not be generalizable across educational

institutions. Despite this limitation, the findings are important as it sheds light on the evolving

profession and increasing demands of healthcare. The findings may indicate a larger concern

regarding the lack of incentive in pursuing an OTD degree as it does not illustrate a conductive

environment for investing potential, yet OTD graduates are engaging and contributing more to

the body of knowledge, profession, and healthcare profession.

Summary and Discussion

The literature review examines the current knowledge on identity and adult learning

theories and how they influence the professional identity formation process of OTD students in

higher education. These professional educational environments resemble CoPs, which utilize

principles of adult learning and identity theories to emphasize the complex nature of the PIF

process. CoPs thrive on the active participation of members to support their collective growth

and identity, highlighting the importance of fostering a sense of belonging among members and

learners. By understanding the vast yet interconnected influences of constructing professional

identity, educators and professional communities can develop effective strategies to facilitate

this

process. Healthcare professions recognize the essential role of their professional members in

maintaining the field’s relevance, collective identity, and contribution to society (Freidson, 1984;

Merton, 1960; Wenger, 1998). Each profession holds a distinct body knowledge for their ways of

practice, encompassing the values and beliefs that shape the norms and standards of members.

These components are essential to establishing a collective identity and unified vision, which are

crucial for attaining the profession’s goals and growth (Kielhofner et al., 2001). Therefore, it is

important for professional communities to understand theories behind identity to support the

profession’s overall effectiveness.

Identity Theory emphasizes how an individual’s role (e.g., student) influences the actions

and behaviors to fulfill the expectations of that role within a specific context, such as in an

academic setting (Stets & Burke, 2022; Stryker, 1968). This theory also highlights that the value

an individual places on a specific role will influence the identity construction process. The higher

the value placed in a role, the greater the investment and commitment is made by the individual.

Social Identity Theory underscores the influence of social group affiliations on shaping an

individual’s identity (Tajfel & Turner, 1986). The individual becomes more aligned with the

expectations and norms of the group through collective interactions, emphasizing the sense of

belonging among members. This sense of belonging and connection promotes the adoption of

standards and values of members, supporting the collective identity. Communities of Practice

highlights the importance of fostering supportive learning environments to enable active

participation and mentorship among members (Lave and Wenger, 1991; Wenger, 1998). CoPs

encourage members to share knowledge and skills through social interaction and networking

opportunities. This continuous interaction between members builds a sense of community that

ensures collaborative lifelong learning and growth of current and incoming members. CoPs are

relevant to education settings, reflecting the interaction between incoming members, field

experts, and the overall profession. Therefore, it is essential to understand the learner and their

learning processes.

Malcolm Knowles (1978) helped shape adult learning education and introduced the

term andragogy, which recognizes the value of centering the learning process around the

learner's needs (Merriam & Baumgartner, 2020). Andragogy posits that adult learners are more

receptive to learning when topics encompass autonomy to connect the learning content and

their professional aspirations driven by internal motives. Self-directed learning encourages

adult learners to reflect on learning experiences to reshape and deepen understanding, which

are also essential principles of Jack Mezirow's (2002) concept of transformative learning.

Mezirow's transformative learning theory supports challenging learning experiences by

allowing learners to critically analyze their current understanding and viewpoints to enable new

ways of knowing. This notion of confronting internal conflicts, such as questioning one's

assumptions, to prompt reflective practices is also an essential component of David Kolb's

concept of Experiential Learning Theory (Merriam & Baumgartner, 2020). Experiential

learning emphasizes real-world or authentic learning experiences for adult learners to see and

apply learned knowledge, supporting principles of andragogy for establishing relevance. The

learning process is optimized when learning content is relevant and paired with the opportunity

to apply and reflect on it. Each adult learning theory mentioned supports one another and

fosters an engaging learning environment for student-centered growth. Given that OTD

students

are predominantly adult learners, adult learning theories are relevant to learning experiences

within OTD education.

Research across professions acknowledges the crucial role of professional education in

preparing learners for professional practice through effective teaching and learning

strategies (Heeb et al., 2020; Krishnagiri et al., 2019; Mitcham, 2014). In OT education,

preparing adult learners to become effective practitioners has undergone significant growth

influenced by societal pressures and paradigm shifts (Brown et al., 2016; Howard, 1991).

Historical events shape the healthcare landscape, prompting the demand for advanced healthcare

professionals to address the increasingly complex medical challenges (Case-Smith et al., 2014).

In response to healthcare trends, OT refined practice and education standards, reflected by the

transition to post-baccalaureate requirements for entry-level practice. More recent literature

highlights an ongoing debate regarding transitioning into an OTD degree as a new standard for

practice to align more with healthcare demands other professions have already adopted (Black et

al., 2010; Noble et al., 2014). Despite the potential benefits of an OTD transition, more support

from OT governing bodies is needed to generate more research for the profession to make an

informed decision. This conversation is necessary due to the expected shift from a

predominantly Master’s level to an OTD-level profession (Harvison, 2022).

To support the advancement of the profession, OT education maintains a clear vision for

deepening the value of occupation through teaching and learning strategies (ACOTE, 2018;

AOTA, 2021). However, a study by Kirshnagiri et al. (2017) highlights an inconsistent approach

across OT education programs for teaching occupation as the core philosophy. This lack of

consistency or absence of teaching the core concept of occupation poses a significant problem as

it impacts the distinctive element of the profession’s identity. Without a distinctive value and

unique contribution in a competitive healthcare market, the profession’s collective identity and

role security is put at risk as other disciplines attempt to replicate and integrate daily activities as

part of their treatments (Ikiugu & Rosso, 2003). Recent literature highlight challenges potentially

stemming from a deficit in occupation-centered understanding where OT graduates report feeling

underprepared, undervalued, and disconnected from their professional role and identity (Cho et

al., 2023; Di Tommaso et. al., 2019; Fortune, 2000; Opuku et al., 2022). Graduates and

practitioners commonly struggle with role confusion and a lack of confidence to advocate the

value of occupation in practice, which can lead to additional stress and burnout (Costa, 2018;

Popova et al., 2023). These challenges are counterintuitive to developing a strong PI as a

profession. The difficulties encountered by new graduates and current practitioners support the

need to assess educational strategies for opportunities to enhance the preparation of future OT

practitioners.

One strategy introduced in OT education is the concept of occupation-centered

education, which links all learning content back to the profession’s core concept and distinctive

contribution of occupation (Fisher, 2013; Hooper et al., 2020; Kielhofner et al., 2001).

Occupation-centered education emphasizes the integration of OT philosophy for fundamental

understanding, core concepts for effective articulation, and consistent linking between learning

and occupation through effective teaching strategies underpinned by adult learning theories. The

approach ensures learning content is relevant and student-centered as it aligns with the learners

professional goals. These are essential components of a sophisticated OT graduate who are

prepared to promote the value of occupation to society (Pierce, 2001). Furthermore, when

graduates can overcome and grasp the challenging concept of occupation, they begin to harness

transformative thinking and seeing in a new occupational way (Fortune & Kennedy-Jones,

2014). This development in OT graduates emphasizes the importance of incorporating effective

teaching and learning strategies intertwined with the professionals values, beliefs, and core

principles to help ensure future practitioners can fulfill the roles and responsibilities expected by

the society. As healthcare becomes more complex and demands more from healthcare

professionals, it is through education and curriculum that will prepare graduates to walk this

path.

The literature demonstrates the value of effectively preparing OT graduates for practice

through strategies, such as occupation-centered education, that integrate the profession's core

values into learning content. This approach ensures graduates have a solid foundational

understanding of OT practice to continue promoting health, well-being, and engagement through

their occupations. Despite recent efforts to instill the profession's and beliefs into graduates,

there continue to be challenges with articulation, preparation, and sense of confidence expressed

by graduates and practitioners (Cho et al., 2023; Di Tommaso et al., 2019; Fortune 2000; Opuku

et al., 2022). Therefore, it prompts exploring other opportunities for enhancing the preparation

process of OT graduates, specifically within PI development through scholarly learning

activities. This study examines the perspectives on learning activities related to research and

academic writing, assessing the potential relationship between these activities and their OTD

professional identity as scholarly professionals.

Statement of Purpose

The purpose of this study was to capture student perceptions to answer the research

question, "how do learning activities related to research and scholarly writing influence the

development of identity as a scholarly professional in OTD students?" The study’s objective was

to understand and describe how these learning activities related to research and scholarly writing

potentially influence the development of a professional identity as a scholarly professional. The

findings from the study can be utilized by OT educational institutions to gain insight into student

development and help determine future strategies for supporting future practitioners.

Theoretical Framework

The guiding theoretical framework used for this capstone project is the Kawa “river”

Model (Iwama et al., 2009; Teoh & Iwama, 2015). The Kawa Model provided a culturally

sensitive and holistic framework to understand the PIF process of OTD students. The model

emphasizes the inseparable nature between the individual, environment, and contextual

influences to foster a holistic view. Integrating the metaphoric river elements offered a lens to

help understand the OTD student experiences as they navigate the academic environment and

develop their professional identities as future practitioners.

The Kawa Model encourages an client-centered interpretation utilized during the

literature review and data analysis to recognize how each perspective shared similarities and

differences while maintaining a neutral position through reflective thinking (Iwama et al., 2009;

Teoh & Iwama, 2015). Through metaphoric representation, the OTD student journey and PIF

process represented the “river flow” to be examined from the participants viewpoint. The model

identifies stakeholder challenges (rocks), denotes opportunities to shift energy (spaces), and

reflects on potential barriers and facilitators (driftwood) within this complex process. This

illustrative approach was helpful for understanding the educational context (riverbanks) and

student experiences that are inseparable components for developing professional identity.

The student researcher and overall professional body have a shared role and

responsibility for promoting harmony in and around our professional communities. The Kawa

Model can be an effective framework for identifying opportunities to enhance flow in clients

and communities (Iwama et al., 2009; Teoh & Iwama, 2015). Therefore, the river framework

was appropriate for understanding the OTD student flow in developing their professional

identity.

Methodology

This study is a component of a larger project examining the importance of research and

scholarly writing in OTD programs, focusing on preparing graduates for both practice and

scholarly roles. This section will outline the research design and approach, the target population,

sampling design, data collection materials and procedures, a pilot focus group study, and

strategies for data management and analysis. Central to this study is the research question, "How

do learning activities related to research and scholarly writing influence the development of

identity as a scholarly professional in OTD students?"

Research Site

The research was conducted at the OTD programs of KUMC and UNLV where each

campus is recognized for their emphasis on research (KUMC, n.d.; UNLV, 2022). Each

institution has its own unique history enriched by their geographic locations and student

populations that contributes to each program’s philosophy. The OT program at KUMC is located

in Kansas City, Kansas, and a part of the School of Health Professions. This institution offers an

OTD program and a Ph.D. pathway into therapeutic science. The KUMC student population

consists of 3,000, of which 1,130 are minorities and 2,400 are graduate students. In contrast,

UNLV's OT programs is part of the School of Integrated Health Sciences and recently launch

their OTD and post-professional doctorate programs during the pandemic. UNLV holds a larger

enrollment of 30,000 students, including 21,000 minority and 4,200 graduate students. The

distinctive qualities of each program offered a valuable perspective for the study.

The student researcher gained access to the research sites through communication with

the OT program directors. The OTDE program director at KUMC, Dr. Janis Davis, guided the

student researcher as the site one mentor who provided training in facilitating focus groups. The

OTD program director at UNLV, Dr. Donnamarie Krause, also assisted the research study as site

mentor two who guided the student researcher throughout the study. The program directors are

involved in a larger research project to examine the influence of scholarly writing and research

in OTD students. This enabled the opportunity for the student researcher to facilitate a small

portion of their research project by facilitating focus groups to capture data from OTD students.

This opportunity aligned with the student researcher’s personal interest of exploring the

development of professional identity, which was incorporated into the current study.

The Capstone Student, Project, and Experience

The student researcher embarking on this capstone journey is a third-year student

attending the UNLV OTD program who will be responsible for planning, organizing, and

facilitating the proposed study. The capstone project encompasses the planning and organizing,

while the capstone experience (i.e., site visit, training, and application) will be the experiential

component (DeIuliis & Bednarski, 2019). The student researcher aims to uncover the essential

experiences influencing the professional journey to gain a deeper understanding. As a result, the

student researcher can strengthen personal and professional self and potentially the development

of others.

Study Design

A descriptive cross-sectional study design utilizing focus groups was adopted to describe

the experiences of OTD students engaging in research and scholarly writing at different stages of

their journey. This research design was appropriate for the study's objectives to capture a current

snapshot of the phenomenon (Taylor, 2017). Descriptive research is well-suited for providing a

detailed account of events, experiences, and attitudes as they naturally unfold. While this design

accurately represents data, it does not establish a cause-and-effect relationship. Instead, it reveals

potential connections and associations limited to the study’s context. The cross-sectional design

was utilized to gain a comprehensive view of the influence of research and scholarly writing by

examining the experiences of three distinct cohorts across two separate OTD programs at a

single point in time during the Spring 2024 semester. The inclusion of six distinct cohorts from

different programs enriched the diversity and representation of data. A cross-sectional

descriptive study design has its strengths and limitations in research.

Descriptive research can be valuable for establishing baseline knowledge in under-

researched areas, laying the foundation for more rigorous research designs (Taylor, 2017).

However, descriptive research may not generate actionable insights to elicit change in

educational practices as compared to experimental designs that can establish causal relationships.

Additionally, cross-sectional research contributes knowledge that is limited to one moment of

time whereas longitudinal studies can provide insight from multiple points in time to see changes

over time. Some additional disadvantages of descriptive research relate to issues in the

trustworthiness of the study findings.

To address some of these drawbacks, the research team incorporated several strategies to

enhance the trustworthiness of the study (Polit & Beck, 2021; Taylor, 2017). For instance,

triangulation, member checks, and research protocols were implemented to support the

credibility and dependability of study. The research team analyzed data individually, compared

findings, and collaborated to form a consensus for conclusions. The student researcher also

facilitated random member-checks by allowing participants to review and verify the accuracy of

data and initial emergent themes. Furthermore, the study’s dependability was enhanced through

the development of protocols for facilitating focus group, data management, and data analysis.

These procedural strategies ensured a level consistency throughout the study, which was also

documented in the student researcher fields notes to ensure transparency in research procedures.

Data Collection

In this study, focus groups were the primary qualitative method to gather data regarding

the OTD students’ experience with research and scholarly writing and its potential impact on

their development as scholarly professionals. This method aligns with the larger project's

objective of collecting student perspectives on research and scholarly writing while supporting

the student researcher’s interest in how these activities can contribute to their identity as

scholarly professionals. The use of focus groups was advantageous for eliciting the students’

diverse perspectives through small group open discussions, offering a deeper understanding of

their unique experiences around research and scholarly writing (Krueger & Casey, 2015;

Stewart & Shamdasani, 2014).

The student researcher utilized information from the literature review and guidance of

faculty and site mentors to develop a focus group protocol (see Appendix A) to ensure a

systematic approach in facilitating focus group discussion which would contribute to the research

question (Hu, 2023; Krueger & Casey, 2015; Rosenthal, 2016; Stewart & Shamdasani, 2014).

The semi-structured interview questions included ten open-ended questions and a series of probe

questions to prompt deeper participant perspectives.

The student researcher received focus group facilitation training from site one mentor

with extensive experience in qualitative research methodologies, providing strategies to promote

participant engagement. To effectively capture observations and document researcher

reflections, a student researcher-created field note template was implemented, as suggested by

site mentor two. Post-session debriefs with site mentors were opportunities to reflect on focus

group

outcomes and receive constructive feedback to refine the facilitation process to ensure

trustworthiness and alignment with the research aims.

The preparation phase was crucial for ensuring the success of the focus group to capture

rich insight from participants, which required the student researcher to maintain flexibility and

adaptability for the inherent challenges of qualitative approaches (Hu, 2023; Krueger & Casey,

2015; Rosenthal, 2016; Stewart & Shamdasani, 2014). Despite rigorous planning, the student

researcher considered the challenges related to group dynamics, participant engagement levels,

and potential bias from both the moderator and participants. The focus group protocol employed

a systematic approach to consider these challenges as the student researcher moderated each

session to minimize the potential disadvantages of running focus groups, enhancing the quality

of collected data. The focus group discussions were facilitated by the student researcher, lasted

approximately between 44 to 80 minutes, and recorded using a standalone audio recorder.

Participants, Sampling, and Recruitment Strategy

The target population of this study were OTD students from KUMC and UNLV. The

research team set out to conduct a total of six in-person focus group sessions, consisting of seven

participants grouped by their respective academic year within the program. This plan captured a

broad spectrum of student experiences from three academic stages at each program between

January and March 2024.

A convenience sampling design was utilized due to the access to research sites and the

accessibility of the population provided by the program directors. The study utilized a non-

probability sampling design with snowball techniques to maximize cost-effectiveness and

participation by leveraging both access and social networks for recruitment (Knis-Matthews et

al., 2021; Polit & Beck, 2021; Taylor, 2017). Additionally, the study offered a ten-dollar gift

card as incentive for completing a focus group discussion. Some disadvantages of this sampling

approach are the potential risks of bias, lack of diversity, and challenges to predict sample size.

However, incorporating these approaches assisted with reaching participants who were less

accessible due to fieldwork or capstone off-campus assignments.

Recruitment was facilitated with three strategies and initiated with an email invitation

(see Appendix B) containing of a digital flyer and information on the capstone study (Appendix

C). Interested participants were directed to sign-up using the provided QR code or Google Forms

link. The online survey collected contact information, academic standing, and basic demographic

information (i.e., gender identity and year of birth) from potential participants (see Appendix D).

This information assisted the student researcher in screening and identifying potential gaps in

sample representation to shift recruitment efforts to underrepresented groups. Following the

email invitations, the student researcher was granted permission by campus faculty to recruit

participants before or after lectures by providing a five-minute scripted presentation regarding

the capstone study opportunity (see Appendix E). The student researcher highlighted voluntary

nature of the study and encouraged word-of-mouth of the study at each encounter with potential

participants, which was beneficial for reaching unavailable participants, such as the site one

second-year students who were out on level two fieldwork.

The student researcher emphasized that participation in the study was voluntary and

urged potential participants to spread the word to their social networks. This approach helped

reach individuals unavailable for a presentation, such as the second-year students on level two

fieldwork. After completing the interest survey and screening process, the student researcher

contacted the participants to discuss their voluntary participation, the consent form process, and

the scheduling of the focus group (see Appendix F). Upon arrival at the focus group, the student

researcher addressed concerns, reviewed the consent form, and provided each participant with a

hard copy for their records.

Pilot Focus Group

A pilot focus group was conducted to assess the overall effectiveness and clarity of the

interview questions, recording equipment, and discussion flow (Taylor, 2017). The pilot focus

group was conducted via Zoom with two participants due to inclement weather at site one. The

virtual focus group was not originally planned or advised, but it was essential for the initial

assessment and refinement of the focus group facilitation process. Feedback from participant

also contributed to the overall quality of focus groups.

Procedures

Preparation Phase:

1. Conduct one focus group to test all equipment, procedures, and discussion questions to

receive feedback and refine process before facilitating operational focus groups.

2. Send recruit emails and provide research presentation to potential participants.

3. Direct potential participants to online interest form to sign up for focus groups.

4. Screen potential participants to ensure they meet eligibility criteria.

5. Contact participants after screening to discuss consent form and scheduling of focus

group.

Pre-Focus Group Setup:

6. Arrive early to prepare focus group setting to ensure a comfortable and

confidential meeting space for discussion.

7. Prepare any necessary materials, such as discussion guide, technology,

snacks, refreshments, and consent forms.

Execution Phase:

8. Begin with a brief introduction of the study's purpose and the focus group's objectives.

9. Remind participants about confidentiality and the importance of open and honest

discussion.

10. Guide the discussion, ensuring all participants have the opportunity to speak.

Data Collection:

11. Use a recording device to capture the discussion.

12. Take brief notes to capture key participant responses.

Post-Session Phase:

13. Gather feedback from participants on their experience.

Documentation and Reporting:

14. Keep a record of the focus group procedure and outcomes.

15. Prepare for debriefing with research team regarding focus group's findings and overall

experience to received feedback and refine as needed.

Data Analysis and Management

Audio files were transferred from the audio device to a password-protected

UNLV Google Drive to prepare for verbatim transcription services (Rev.com). The audio

files were then imported into the secure transcription service database to begin

transcribing the audio files. At the conclusion of the final focus group session, the student

researcher began listening and reading the completed transcripts to verify the accuracy of

the transcripts against the audio recordings on the transcription platform. During this

process, the student researcher removed any sensitive data and corrected errors to ensure

readability. Upon completion of the review, the transcript file was exported back onto the

password-protected Google Share Drive to prepare for

data analysis using ATLAS.ti software (Version 23.3.0; Scientific Software Development,

Berlin, Germany). The data management software was helpful in organizing the large amount of

focus group data while enabling collaboration between the student researcher and two site

mentors as they performed a content analysis (Krippendorff, 2018).

The research team maintained a copy of all records in a secure facility at UNLV or stored

electronically in a password-protected UNLV Google Drive. Access to all files was restricted to

the research team only and regularly assessed for sensitive data, de-identifying sensitive data to

ensure the confidentiality of participants. The research team will delete any unrelated research

data immediately, and all collected data from the study three years after the study's conclusion.

Latent content analysis was selected to analyze the data in order to gain a more in-depth

interpretation of the focus group data as opposed to a manifest approach that produces a more

surface-level understanding (Krippendorff, 2018). A four-stage content analysis framework

described by Bengtsson (2016) was used to systematically break down the focus group content to

uncover the underlying meanings. The framework enabled the research team to generate the sub-

codes, code groups, and categories emerging from the data through inductive reasoning. This

reasoning approach challenged the research team to maintain a neutral position to minimize bias

as they formed interpretations of data, which was enabled through constant reflective practices

and deep discussions throughout the data analysis process that kept the research question at the

forefront. The research team procedures for conducting the stages of analysis through Atlas.to

are described in the following:

Stage 1: Decontextualization. The research team independently familiarized themselves

with the initial transcript by repeatedly reading the data to develop preliminary codes.

The research team noted their coding thought processes directly on the ATLAS.ti

application through its memo feature or directly on the code. Additionally, the student

researcher created a codebook to document code definitions, providing an accessible and

transparent guide for the research team to reference for analysis and debriefing

discussions (see Appendix G). The researchers debriefed together before completing a

full analysis of the initial transcript to discuss and establish a consensus on the direction

of the coding process. Additionally, the team implemented a bi-weekly debrief plan to

present, discuss, and compare their individual findings, facilitating triangulation and

focused analysis to answer the research question.

Stage 2: Recontextualization. At this stage, the research team revisited the coded

transcripts during debriefings to discuss further connections between codes and ensure a

level of consistency was maintained throughout the analysis process. The regular check-

ins were crucial for enabling the student researcher to maintain objectivity by distancing

themself from the data and avoid losing sight of their research objectives. The research

team debriefings focused on evaluating the codes with contextual information to ensure

the accuracy of code meanings among the researchers and adjusting or condensing the

codes as needed. The research team took note of emerging coding patterns and themes,

which became more apparent and applied to subsequent transcripts. This process was

repeated to ensure all relevant content was reviewed and unnecessary data was removed.

Stage 3: Categorization. This stage was initiated after coding all transcripts where the

research team began grouping the initial codes as sub-codes under code groups based on

similar underlying themes and patterns. The student researcher was responsible for the

initial grouping of codes and presented their findings to site mentor two for further

analysis, refining code groups to ensure accuracy. Once code groups were created and

validated by site mentor two, they were reviewed again by site mentor one to ensure their

accurately captured the essence of the sub-codes. This process was repeated until a

complete agreement was reached to proceed with generating categories, which followed

the same steps as forming the code groups. Categories encompassed the code groups to

begin forming a broader theme and narrative that is described in the results section.

Stage 4: Compilation: In the final stage of data analysis, the research team combined the

categorization and theme-generation process due to time constraints. However, this did

not deviate far from the four-stage process they planned. The student researcher began

shaping a narrative using the categories to capture the underlying meanings that

connected the sub-codes and code groups to the categorizing theme. Direct and

paraphrased quotes were then selected from the transcripts to support the interpretations

and reviewed by the research team, which can be reviewed in the research team’s Master

Code Book Table (see Appendix H).

Ethical and Legal Considerations

Approval from the UNLV Institutional Review Board (IRB) was granted for the

research study. All data was treated as sensitive and handled with the utmost care. A

copy of all records was regularly be updated and kept with the primary investigator,

which was stored in a locked facility at UNLV and secured in an encrypted and

password-protected computer until the completion of the study. Sensitive information

was kept in a secured/password-protected database for electronic data, while physical

data (e.g., papers and master code books) was locked in cabinets/drawers with the

primary investigator. Data from non-participants was destroyed immediately after

confirming withdrawal or within five days of non-participation (i.e., no communication

and no show), consisting of deleting electronic files, deleting electronic files from trash,

and shredding any hard copy information. Retaining data from participants was only be

kept from participants who completed the study, which will be destroyed seven years

after the study's conclusion. The student researcher facilitated weekly reviews and audits

to ensure the security of sensitive data. The student researcher maintained a secure log to

document procedures to annotate data and methods for data destruction.

Results

This section contains the results from the data analysis described in the previous section.

It will describe the sample characteristics from both research sites and the data analysis results.

The categoric themes are briefly introduced and followed by a table that breaks down each

category by its code groups, sub-codes, definitions, and direct quotations.

Characteristics of the Sample

To ensure the confidentiality of participants, characteristics will be described as

population groups. Thirty-two participants in Table 1 engaged in the focus groups from both

OTD programs. This sample size was ten fewer participants than anticipated. The site

availability of participants may have been impacted by Level II fieldwork rotations and capstone

experiences, contributing to the lower participation rates. The population group at site one was

dominantly female (n=16), with participants in the 20-24 and 25-29 age brackets. In contrast, the

population group at site two included seven males in their group of 16, with participants ranging

from the 20-24 to 45+ age brackets. Furthermore, seven participants from both population groups

indicated having prior focus group or research-related experience.

The two sites showed a noticeable contrast when comparing the population

characteristics of participant groups from each OTD program. The population group at site one

was mainly homogeneous regarding age and gender, whereas, at site two, there was greater

diversity among participants. Although ethnic background data was not collected, the student

researcher observed that most participants at site one were white. This contrast between

population groups may indicate potential differences in program appeal or recruitment

strategies.

Table 1

Participant Demographics

Item Number

Site KUMC 16

UNLV 16

Year in School One 16

Two 7

Three 9

Gender Male 7

Female 25

Age 20-24 13

25-29 12

30-34 3

35-39 2

40-44 0

45+ 2

Prior Experience Yes 7

No 25

Note. n=32 for sample size; KUMC = Kansas University Medical Center; UNLV = University

of Nevada, Las Vegas

Category One: Empowerment and Challenge in the Academic Environment

Category one captures students' experiences as they navigate, overcome, and experience

academic hurdles while highlighting their growth during this process. This category has two code

groups: academic challenges (with three sub-codes) and student growth (with two sub-

codes) listed in Table 2 (see Appendix H). The academic difficulties code group consists of three

sub-codes. The first pair of quotes is assigned to the emotional and motivational challenges sub-

code, capturing some of the difficulties OTD students face that impact their performance. The

second pair of quotes highlights issues with balancing academic demand experienced by

participants, which falls under the expectations and workload balance sub-code. The final sub-

code under the academic challenges code group, understanding and applying knowledge

challenges, sheds light on student challenges by generating relevance to retain academic

knowledge. The student growth code group includes two subcodes. The first sub-code,

confidence and resilience, captures participant reflections of moments as they experience growth

and validation through the application. Participants expressed transformation and learning-

related development in the second pair of quotes, which fall under the learning and emotional

growth sub-code.

Category Two: Bridging Theory and Practice through Curriculum

Category two highlights the importance of the learning environment, curriculum design,

and student understanding assessment. This category brings attention to the external influences

and contains one code group, influences on learning, with four sub-codes listed in Table 2 master

codebook (see Appendix H). The first sub-code, application, and integration of practical

knowledge, capture student perspectives on specific learning experiences that enhanced their

understanding of OT practice. The learning environment, identified as the second sub-code,

emphasizes a nurturing learning environment through effective educator practices. Next, the

teaching strategies sub-code underscores the importance of providing students with ample

practical application opportunities, enhancing their understanding. The last sub-code recognizes

the role of supportive learning networks, emphasizing a sense of community for members to

interact and share knowledge.

Category Three: The Odyssey of Becoming: An Embodied OT Identity and Scholarly

Professional

Category three encapsulates professional identity development and scholarly

aspects, highlighting reflective practice, challenges, and the integration of research skills

for evidence-informed practice. This category has one code group, scholarly engagement,

professional development, and PIF, with three sub-codes listed in Table 2 master codebook (see

Appendix H).

The first sub-code, building research proficiency for professional practice, consists of

student reflections on the role of learning activities related to research in their development and

future practice. Next, difficulties that arise during or around the research process are captured

under a sub-code to highlight barriers participants face with research engagement. The final sub-

code, scholarly engagement, and lifelong learning reflects participants' integration of evidence-

informed practices to demonstrate academic growth.

The study results encompass a diverse sample of participants and offer insight into their

experiences. Of the 32 participants, a majority were females in the younger age ranges. Site two

participants had a more significant gender and age diversity, while site one had a more

homogeneous sample of participants. This variation may indicate potential differences between

OTD programs regarding program appeal and recruitment. The data analysis revealed three

thematic categories, encompassing code groups that comprise sub-codes to capture the meaning

behind the data. Category one, empowerment and challenge in the academic environment,

highlights growth experiences from overcoming challenges. The second category, bridging

theory and practice through curriculum, focuses on the participants’ demonstration of enhanced

knowledge through learning. The last thematic category, the odyssey of becoming an embodied

OT identity and scholarly professional, captures the essence of developing an evidence-informed

reflective professional identity. The data-driven and emergent findings provide a comprehensive

interpretation, which will be discussed in the next section.

Discussion

This section will discuss and interpret the findings described in the results section from

the student researcher’s perspective, which will be followed by summary of the interpretations

and an implications section. The discussion will draw on the Kawa Model to analyze the

emerging themes from the focus group data, aiming to build an understanding of the OTD

student experiences (Iwama et al., 2009; Teoh & Iwama, 2015). The Kawa Model lens will focus

on interpreting the challenges (rocks), contextual influences (riverbank), facilitators and

inhibitors (driftwood), and overall academic journey of becoming practitioners (river flow).

River Flow

The river's flow represents one component of the PIF process: OTD student educational

preparation (Iwama et al., 2009; Teoh & Iwama, 2015). The participant's narrative captured

through the focus group discussions will help illustrate this process for interpretation. Although

the river metaphor can depict a comprehensive view of the students experience, this study

focuses on experiences with learning activities related to research and scholarly writing. It is

important to note that the PIF process is multifaceted and ongoing throughout one’s career but

heavily influenced and initiated during education and training (Adams et al., 2006). It is through

the academic environment and encompassing learning experiences where students begin to

develop a deeper understanding and connection to a chosen professional field. These

components are important to assess how An assessment of the students’ academic experience can

provide insight develop the essential skills for implementing evidence-informed practices

expected from OTD students.

Rocks (Challenges)

The challenges that student face are represented as rocks, which can impede the river’s

flow (Iwama et al., 2009; Teoh & Iwama, 2015). Participants identified many personal and

professional challenges they faced during their academic journey, which impact various aspects

of their individual river’s river flow. Participants described feelings such as being overwhelmed,

underprepared, and frustrated as they navigate challenges and overcome obstacles. Rocks

encompass the challenges of seeing and understanding the relevance, application, and connection

between their learning experiences and future roles. For instance, participants noted a heavy

academic obligation to learn a vast number of topics, which impacts their ability to engage in

meaningful activities due to limited time outside of the classroom. Additionally, participants

expressed a lack of clarity and preparation to successfully integrate complex concepts and topics.

These rocks can narrow or restrict the river’s flow and act as barriers in development.

Driftwood (Resources and Assets)

The student’s personal traits, beliefs, and access to resources can either hinder or

facilitate progress, representing the river’s driftwood that can block or move rocks to influence

flow (Iwama et al., 2009; Teoh & Iwama, 2015). Student responses highlight educator

mentorship, peer collaboration, and practical learning experiences as most beneficial to their

developmental journey. A synergy between educator guidance and peer-to-peer support systems

enables student to over challenges.

Riverbanks (External Factors)

The learning environment teaching and learning strategies represent the riverbank that

guides the student’s academic journey (Iwama et al., 2009; Teoh & Iwama, 2015). Students

identify fieldwork and service-learning settings as influential learning experiences for personal

and professional development as it enables students see the relevance and practical application of

classroom knowledge. Additionally, participants report that competency-based and clinical-

simulated learning experiences promote engagement and empower students to facilitate

evidence-informed practices to support their clinical reasoning and approach.

Spaces (Opportunities)

The spaces in the river’s flow highlight areas that could be optimized to enhance flow or

create new streams for water to flow (Iwama et al., 2009; Teoh & Iwama, 2015). The

opportunities for enhancing student growth and readiness highlight experiential learning

experiences underpinned by real-world relevance and beyond. Participant responses reflect a

shared level of uncertainty and confusion in establishing the purpose and meaning behind certain

learning content, which can delay understanding and increase academic stress. In addition to

increased stress from having to backtrack on course content in a demanding program, the

students are less likely to acquire and retain essential knowledge and skills for their professional

roles.

The discussion section enabled an interpretation of the findings through a Kawa Model

lens to understand the OTD professional development journey through the student's perspective.

This river interpretation highlights the multifaceted process of professional identity formation in

OTD students, providing understanding through river elements. The elements represent student

challenges, resources, and external influences impacting their learning experience. In summary,

the findings provide preliminary data for educators and researchers to expand knowledge in OTD

student development and potentially shape the profession's future.

Implications for Research

This study underscores the need for further research on developing professional identity

in OT education as it provides preliminary insight into how learning activities related to research

and scholarly writing may influence this process from the OTD student perspective. More

research assessing the student perspective can ensure a student-centered approach in educational

preparation. Longitudinal research can extend the understanding of OTD student PIF process by

measuring their development in the long-term, shaping the direction of education practices.

Further research should evaluate the impact of specific learning activities to determine efficacy

of strategies.

Implication for Practice

This study highlights the importance of integrating experiential learning, effective

mentorship, and reflective practices to optimize the development of students, which is relevant

for OT educators and potential fieldwork supervisors. The findings highlight the challenges

students face during their educational journey as they shape their professional identities. This

insight should be considered when designing or promoting the development of professionals to

ensure adequate support and preparation.

Limitations and Assumptions

Limitations

Restricted to KUMC and UNLV OTD students, impacting the ability to generalize

to other OTD Students

Audio recording and limited notetaking may have resulted in missed nuanced

interactions.

Differences between research sites could affect participant responses.

Assumptions

Assumes active and honest engagement in discussions by participants.

Presumes participants have a clear understanding of research procedures and goals.

Trustworthiness in the research processes and practices by the research team.

Conclusion

This capstone project utilizing the Kawa Model as a theoretical lens provides

insight into how learning activities related to research and scholarly writing influence the

development of professional identity of OTD students. The findings illustrate the

interplay between the challenges (rocks), supportive resources (driftwood), educational

environment (riverbank), and opportunities for further growth (spaces) that collectively

influence the student's flow in the academic journey. These illustrative elements were

created based on the OTD student perspectives shared during focus group discussions.

The findings demonstrate how various factors, such as challenges (rocks), supportive

resources (driftwood), educational environment (riverbank), and opportunities for further

growth (spaces), interact and affect a student's academic journey. These elements were

created based on the perspectives of OTD students and aligned with the findings of

across OT literature regarding the challenges faced in practice. This study advocates for

the continuing refinement of educational practices and incorporating the student

perspective in designing education to optimize future practitioners' preparation. Further

research on developing professional identity should be explored to reflect the

profession's commitment to excellence.

Building Professional Identity Through Scholarly Activities Insights from OTD Students

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