Written by: Mirella Deisher, OTD, MS, OTR/L, CHT
Virtual Hand to Shoulder Fellowship, LLC
Faculty & Founder
Many hand therapy clinics are hesitant to take students, and for good reason. In an orthopedic hand clinic, the injuries can be quite complex, and the rehabilitation process leaves little margin for error. The consequence of error can leave patients with suboptimal outcomes or even the need for another surgery.
I’ll be honest, when I was director of hand therapy, I didn’t take fieldwork students. It was hard just to find CHTs to accommodate a quickly growing orthopedic practice. Instead, I put my energy into developing a hand therapy fellowship that included a comprehensive didactic curriculum because I knew that this specialized level of knowledge was not part of OT education which is designed to prepare clinicians as generalists. The hand therapy fellowship then served as a means of recruitment that allowed us to hire new grads and develop their knowledge base and clinical skills through an onsite curriculum and mentorship.
I’ve always been interested in how OTs are educated, primarily with a focus on why OTs don't appear to be as equipped to support the remediation of physical impairments at the same level as physical therapists. This was something I first noticed as a patient, having the opportunity to compare my experience with PT versus OT in the rehabilitation of impairments affecting both my lower and upper limbs. I wasn’t a therapist at the time and had never heard of occupational therapy, but my honest observation was that PT was invested in helping me achieve my goal of walking as normally as possible by doing tangible activities such as strengthening, and balance and gait training. However, it was harder for me to appreciate whether we were doing things in OT that would help me achieve my goals of restored upper limb and hand function.
A few years after my experience as a patient, I explored both professions as a potential career, and I chose to become an OT, because I do believe in its potential to serve patients using a holistic approach. I use the word “potential” because holistic must include the physical with equal emphasis to the psychosocial, and I’m wondering if the physical is getting equal and adequate attention academically within OT curriculums. Once I began working in physical rehabilitation settings side-by-side with physical therapists, I could see the difference in critical thinking skills, and I could see that if I wanted to optimize my effectiveness in upper limb and hand therapy, I had a very large knowledge gap to fill. In addition to being a new grad, I also lacked the scope of knowledge that I realized would allow me to best serve my patients, even those with neurological impairments. So now wearing my OT "hat" I understood my personal OT experience as a patient. My OT had a different approach to care than my PT. I’m not saying one is better than another in every context; however, if the focus is on the remediation of physical impairments (which is what I wanted as a patient), I’d generally feel more confident in the PT because their curriculums are concentrated on developing related competencies. In comparison, OT curriculums are much broader in scope.
Ultimately, everything I’ve done as an occupational therapist is a direct result of my personal experience and my desire to be an OT that can serve patients at the highest level in upper limb and hand therapy. Thus, a year into my OT career, I enrolled in an upper limb and hand therapy certificate program offered within a PT program. That was 23 years ago, and this program is still offered at Thomas Jefferson University and led by Jane Fedorczyk, PT, PhD, CHT. It basically put me on a launch pad to grow my knowledge and skills in my chosen specialty of upper limb and hand therapy. Thereafter I grew my knowledge very intentionally as I worked alongside hand surgeons.
My interest then turned to addressing this knowledge gap for other OTs (and PTs) wanting to optimize in their ability to support the remediation of upper limb and hand impairments. So, in 2012 I began developing clinical hand therapy fellowships, and in 2020 translated the curriculum to accommodate online learning and mentorship through the development of the Virtual Hand to Shoulder Fellowship.
Fast forward to present day; I’m now also adjunct faculty within a doctoral OT program with the first class of OTD students about to start their fieldwork experiences. While I know I did my best to educate them in Anatomy and Neuroanatomy and connect the dots to clinical practice; I came to recognize that critical thinking skills can only effectively develop once they process this information in a meaningful way with patient care. However, there was a year between taking anatomy & neuroanatomy and the start of their clinical fieldwork experiences.
For this reason, I decided to create the Fieldwork Support Program, and the first class of Cedar Crest College OTD students is my pilot cohort. For those students going to a hand therapy clinic or outpatient rehab, the intent is not only to support the students but also the fieldwork sites. Creating curriculums that optimize student performance during their fieldwork is another gap that can be filled for the good of the student, the patient, and the fieldwork site. I look forward to seeing how this pilot group does, and then making needed adjustments based on feedback and metrics.
The bottom line to all this leaves me stating the obvious; we need to supplement our educations in a comprehensive manner that cultivates advanced critical thinking, particularly as clinicians begin identifying a specialty focus.
Both physical and occupational therapy professions are addressing this need through fellowship programs which were in their early stages of development back when I started developing the hand therapy fellowship in 2012, but have since exploded in number and in a variety of specialty areas. This is confirmation that there is agreement on learning needs for both PT and OT, and I think the more clinics and hospitals that offer fellowships, the better.
As for our fieldwork students, maybe offering curriculums to support them during fieldwork would better cultivate critical thinking skills and also facilitate prospective fieldwork sites to take on more students. Given how challenging it has become to secure fieldwork sites, this is an area worth exploring.
