Professional identity and workplace motivation: A case study of health information managers

BACKGROUND

The professional identity and motivation of qualified health information managers (HIMs) is largely unexplored.

OBJECTIVES

A larger study has investigated the motivators of HIMs in the construction of their professional identity and associated relationships to job satisfaction and engagement with their profession. The aims of this component of the study were to: (i) identify and analyse the characteristics of members of the profession who have different motivation profiles; (ii) obtain HIMs' perspectives on their professional identity; and (iii) measure correlation between HIMs' professional identity and different motivating factors. Method: A cross-sectional study design, with a convergent mixed-methods approach to data collection was employed. An online survey was administered to the 1985, 1995, 2005 and 2015 Australian health information management and medical record administration graduate cohorts from one university in Victoria.

RESULTS

Response rate: 72.7% (n = 72). There were no statistically significant correlations between the HIMs' motivation profile and professional identity. The HIMs were largely motivated by a need for achievement (striving for excellence) and continuous improvement; maintained high standards of work quality (95.8%); valued their work (94.4%) and work collaborations (84.7%); satisfactorily applied skills-knowledge (94%); demonstrated a very strong professional association (92% were proud to belong to the profession). Key factors in motivation that were consistently reported by members of all cohorts in the open-ended questions were as follows: intrinsic motivation; colleagues and teamwork; the variety of work performed; and contribution to the bigger picture. Overall, and notwithstanding between-cohort differences: 65.3% confidently directed others, 45.8% aspired to leadership and 38% actively networked. They related difficulty in explaining the profession to outsiders.

CONCLUSION

There was no correlation between motivation profile and professional identity. Significantly, the HIMs demonstrated exceptionally strong positive professional identity, reflected particularly in pride in membership of the profession and their belief in the importance of their professional work.

The Occupational Therapy Profession in Saudi Arabia

Objective

To provide an evidence-based description of how the occupational therapy profession operates in Saudi Arabia.

Methods

A case study methodology set out an evidence-based description of occupational therapy in Saudi Arabia. Three procedures were used: (1) a structured narrative review of publications on occupational therapy in Saudi Arabia based on searches of seven healthcare databases; (2) an audit of "grey literature" about or referring to occupational therapy education, practice, research, or the profession in Saudi Arabia using Google Scholar, Google search, official documents and websites, and relevant global organisation such as the WFOT website and documents; and (3) consultation with occupational therapists to further discuss emerging evidence from peer-reviewed articles and grey literature about occupational therapy in Saudi Arabia. Data were collected in Arabic and English. Findings. Occupational therapy in Saudi Arabia is a rapidly growing and emerging profession primarily focused on rehabilitation practice. Between 2010 and 2019, seven academic organisations commenced bachelor's degree programmes. Occupational therapy services in Saudi Arabia are concentrated in city-based secondary and tertiary healthcare services targeting rehabilitation and disability support. The practice aims to promote the reduction in impairment and increase activity performance and participation in valued life roles. Despite the increasing demand for occupational therapy services, there needs to be more access to and availability of their services. Enhancement of the awareness of occupational therapy among the public and other healthcare professionals is needed. A consistent definition of occupational therapy in Saudi Arabia would strengthen the profession, along with a national scope of practice, practice guidelines, increased workforce and development, and professional education information.

Conclusion

Occupational therapy in Saudi Arabia is growing regarding the size of the workforce and the number of programmes and services provided, thus contributing to the health and well-being of the population primarily through rehabilitation. Further development of the profession is necessary.

An Exploratory Study: Undergraduates' Perspectives on how Threshold Concepts Influence Professional Identity

Background. Threshold concepts are key to professional identity development, transforming the way individuals think, act, and perceive the world. Purpose. To understand how occupational therapy students describe their professional identity, its importance, and how threshold concepts contribute to identity. Method. Mixed-method survey of final-year occupational therapy students (n = 58) at an Australian University. Findings. (i) High agreement on most identity and threshold questions; but up to 24% uncertain about confidence/competence in understanding specific concepts; (ii) occupation-focus is unique to our professional identity; (ii) identity develops over time; (iii) occupation-based, client-centered, and evidence-based practices are central to thinking like and becoming an occupational therapist; and (iv) practice education provides context for threshold concepts to be transformative. Implications. Identity is defined by a focus on occupation and its relationship to health. Traversing threshold concepts through academic and practice education is essential to developing professional identity.

The personal dimension of allied health professional identity: A scoping review in health sciences literature / Die persönliche Dimension der beruflichen Identität von Gesundheitsfachkräften: ein Scoping-Review in der gesundheitswissenschaftlichen Literatur

Introduction

With a shift in healthcare from diagnosis-centered to human- and interprofessional-centered work, allied health professionals (AHPs) may encounter dilemmas in daily work because of discrepancies between values of learned professional protocols and their personal values, the latter being a component of the personal dimension. The personal dimension can be defined as a set of personal components that have a substantial impact on professional identity. In this study, we aim to improve the understanding of the role played by the personal dimension, by answering the following research question: What is known about the personal dimension of the professional identity of AHPs in (allied) health literature?

Methods

In the scoping review, databases, CINAHL, ERIC, Medline, PubMed, and PsychINFO were searched for studies focusing on what is regarded as ‘the personal dimension of professional identity’ of AHPs in the health literature; 81 out of 815 articles were included and analyzed in this scoping review. A varying degree of attention for the personal dimension within the various allied health professions was observed.

Result

After analysis, we introduce the concept of four aspects in the personal dimension of AHPs. We explain how these aspects overlap to some degree and feed into each other. The first aspect encompasses characteristics like gender, age, nationality, and ethnicity. The second aspect consists of the life experiences of the professional. The third involves character traits related to resilience and virtues. The fourth aspect, worldview, is formed by the first three aspects and consists of the core beliefs and values of AHPs, paired with personal norms.

Discussion

These four aspects are visualized in a conceptual model that aims to make AHPs more aware of their own personal dimension, as well as the personal dimension of their colleagues intra- and interprofessionally. It is recommended that more research be carried out to examine how the personal dimension affects allied health practice.

Evolution of professional identity in Iranian occupational therapy students and new graduates: A comparative study

Introduction

The development of professional attitude evolves over time and contributes to the formation of professional identity. This study tracked formation of professional identity by comparing professional attitudes of three cohorts: new graduates, final-year, and first-year students of occupational therapy.

Method

The online survey, including a 5-point Likert scale 17-item questionnaire and one qualitative inquiry using an incomplete statement, revealed the perception and future career prospects of 144 novice practitioners and students of occupational therapy. Written statements were compared to each other to provide insight about the participants’ perspectives during the three time periods.

Findings

One-way ANOVA indicated that there were significant differences in professional attitudes among the three cohorts (F (2, 141) = 14.32, p < 0.0001), demonstrating a downward trend in professional identity formation. The comparison analysis of statements confirmed the quantitative results and highlighted an issue of negative professional identity through indicating great concerns over the future career prospects.

Conclusion

Despite increased awareness of occupational therapy over time, these participants seemed to have had trouble developing a sound sense of professional identity. Possible sources and solutions for this issue were discussed, to better facilitate a clear sense of professional identity in occupational therapy students and practitioners.

Describing the end-of-life doula role and practices of care: perspectives from four countries

Background:

End-of-life doulas are emerging as a potentially important new form of community-based caregiving in the global North, yet we know little about this form of care. The aim of our study was to solicit the perspective of key stakeholders and early innovators in community-based end-of-life care about the development and practices of end-of-life doulas.

Methods:

We conducted 22 semi-structured interviews with participants in four countries where end-of-life doulas are most active: Australia, Canada, the United States, and the United Kingdom.

Findings:

This article focuses on participants’ description of the end-of-life doula role and attendant practices, and our findings provide the first detailed taxonomy of the end-of-life doula role and specific services on the basis of the perspective of subject experts in four countries. We situate our findings within literature on the professionalization of caregiving, with particular attention to nomenclature, role flexibility and boundary blurring, and explicit versus tacit knowledge. We also discuss the importance of jurisdictional considerations as the end-of-life doula movement develops.

Discussion:

We speculate that the end-of-life doula role is potentially experiencing common developmental antecedents similar to other now-professionalized forms of caregiving. Our findings contribute substantial new information to the small body of empirical research about the end-of-life doula role and practices, provide critical firsthand insight as the movement develops, and are the first research to explore end-of-life doulas from a comparative international perspective.

"Like a nurse but not a nurse": Clinical Research Practitioners and the evolution of the clinical research delivery workforce in the NHS

BACKGROUND

Clinical research is increasing across the United Kingdom. Within the context of a shortage of nurses, trusts have struggled to maintain research capacity. In order to meet staffing demands, trusts have increasingly turned to Clinical Research Practitioners (CRPs) to assist in the delivery of clinical research. Initially an ad hoc workforce, the CRP role is being formalised and professionalised. This study is a close examination of the clinical research delivery workforce at one research-intensive acute trust in the United Kingdom, with a focus on the emerging CRP staff group.

METHODS

The study was conducted in a large inner-city teaching hospital (acute trust) in London, United Kingdom. Data were collected between September and December 2017. Twenty-five staff were interviewed across 11 different directorates. Interviews were semi-structured with an overall focus on research staff backgrounds and roles, as well as their perceptions and experiences of careers in research. The data were managed using NVivo 11 software and analysed thematically.

RESULTS

CRPs are drawn from a wider pool of educational and employment backgrounds than their nurse colleagues, and actively seek out work in health research. CRPs receive on-the-job training to acquire the competencies that are necessary for them to carry out their work. The CRP role, which began in an ad hoc manner, has become regularised, yet remains to be well defined, which can be a source of frustration for CRPs and those who work with them.

CONCLUSIONS

The professionalisation of the CRP workforce represents an opportunity for the health research system to employ research workers who possess a range of in-demand skills and to shore up research capacity in the context of the shortage of nurses.

Craftivism for occupational therapists: finding our political voice

Craftivism is an ongoing movement, combining craft with activism, to bring about positive change in the world. There is a growing emphasis on the need for occupational therapists to engage with the politics of the profession to tackle occupational challenges and injustice. This opinion piece considers whether, with the historical links to and resurgence of craft internationally within the profession, now is the time for occupational therapists to engage in craftivism to effect positive change and transformation for a just and inclusive society. It suggests that craftivism may enable the profession to find its political voice and suggests ideas for action.

Contemporary factors shaping the professional identity of occupational therapy lecturers

Introduction

The contemporary factors of neoliberalism and evidence-based practice have implications for professional autonomy and values, education and training, ways of working and construction of knowledge. Occupational therapy lecturers are at the interface between student education and professional practice and therefore have unique insights into the way in which these factors are shaping their professional identity and that of the profession.

Method

Nine narrative inquiry focused interviews of occupational therapy lecturers from two universities were carried out. Data was interpreted through a Bourdieusian lens of professional habitus, and analysed thematically.

Findings

The main factors influencing occupational therapy lecturer identity were noted to be relationships between professional identity and artistry; the professional body of knowledge and language; evidencing practice, neoliberalism and changes to teaching and learning.

Conclusion

The structural factors of neoliberalism, evidence-based practice and associated policies are influencing the occupational therapy professional habitus and, in turn, occupational therapy lecturers’ professional identity. An effective critique of these structural factors is required to maintain the profession’s values and artistry and the knowledge upon which occupational therapy lecturers’ identity is formed and their approaches to teaching and learning are based.

The Dr Elizabeth Casson Memorial Lecture 2018: Occupational stories from a global city

The Dr Elizabeth Casson Memorial Lecture 2018, given on June 12th 2018 at the 42nd Annual Conference and Exhibition of the Royal College of Occupational Therapists, held at the Belfast Waterfront, Belfast, UK.

This lecture aims to set out the potential for the global occupational therapy profession to exchange knowledge for social transformation practice. It identifies the profession’s concern with narratives as a vehicle for a socially critical approach to occupation, which can be used to negotiate intervention and action. Drawing on examples from literature, history and service users, the paper suggests that narrative provides a means for relating the value of occupation beyond professional boundaries to capture popular imagination and demand for the profession. Examples are given of the critical discussion of the everyday impact of health inequity, and in addressing diversity both in the profession and engaging service users.

My lecture concludes that occupational therapy is a global network with the population of a city, and thus represents a community that can be a vibrant voice for social transformation through occupation through a reciprocal exchange of narrative. This is a collective and dialogical process which can draw on the experiences of both southern and northern hemispheres.

A case study of the development of occupational therapy at St. Patrick’s Hospital Dublin, 1935-1969

Purpose

This paper aims to examine the relationship between psychiatry and occupational therapy in Ireland through a case study of the development of the occupational therapy department in St. Patrick’s Hospital, Dublin, from 1935 to 1969. Patronage by psychiatrists was an important factor in the professionalisation of occupational therapy internationally.

Design/methodology/approach

Documentary sources and oral history interviews were analysed to conduct an instrumental case study of occupational therapy at St. Patrick’s Hospital from 1935 to 1969.

Findings

The research identified key individuals associated with the development of occupational therapy at St. Patrick’s Hospital, including psychiatrist Norman Moore, occupational therapy worker Olga Gale, occupational therapist Margaret Sinclair, and social therapist Irene Violet Grey. Occupational therapy was considered by the hospital authorities to be “an important part in the treatment of all types of psychiatric illness” (Board Meeting Minutes, 1956). It aimed to develop patient’s self-esteem and facilitate social participation. To achieve these objectives, patients engaged in activities such as dances, arts and crafts, and social activities.

Originality/value

This study has highlighted the contributions of key individuals, identified the links between occupational therapy and psychiatry, and provided an insight into the development of the profession in Ireland prior to the establishment of occupational therapy education in 1963. Occupational therapy practice at St. Patrick’s Hospital from 1935 to 1969 was congruent with the prevailing philosophy of occupational therapy internationally, which involved treatment through activities to enhance participation in society.

Understanding clinical reasoning in osteopathy: a qualitative research approach

Background

Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions.

Methods

This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories.

Results

According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions.

Conclusions

The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care.

Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines.

Unique core skills: Exploring occupational therapists' hidden assets

Introduction

Early literature considered occupational therapists' unique core skills in terms of visible activities. Suggestions of what these may be have often confused skills with techniques and personal attributes and thus arguably have had some negative consequences for the profession.

Method

An electronic and hand-searched review of past and present professional and adjunctive literature led to the inductive development of five themes: an historical perspective of core skills; defining occupational therapy; the occupational therapy process; practice skills and defining unique core skills.

Discussion

Literature has indicated that occupational therapists' unique core skills are those common non-visible skills based around unique reasoning processes that translate occupational therapy theory and knowledge into visible professional practice. Visible skills are context dependent and should not be seen as core.

Conclusion

The unique core skills of occupational therapists are largely hidden. They are the reasoning skills used to apply the understanding of occupation and its impact on health to the meaningful activities and occupations of service users. Visible practice skills are diverse and some may be shared with other professions. While some activities can appear mundane, forming the rationale for their use is the unique core skill of occupational therapists.

A debate on the professional identity of occupational therapists

Introduction

The issue of occupational therapy’s professional identity has been debated for many years and continues today. Lack of clarity has resulted in occupational therapists’ perceptions of holding a low status and of colleague and public misunderstanding.

Method

A range of international literature was reviewed. Inductive analysis elicited two major themes – reasons for issues with identity and the consequences of issues with identity. The development of communities of practice is discussed.

Results

The analysis of the causes and consequences of issues with professional identity was used to suggest how the profession might become a mature community of practice. Lack of deep knowledge of the profession’s unique beliefs was shown to cause inconsistent messages about its identity. Consequently, practitioners believed they were undervalued. Understanding, owning and reinforcing an occupational paradigm were seen as vital elements for creating professional communities of practice.

Conclusion

To function as a community of practice requires occupational therapists to use a range of strategies that reinforce their unique occupation-based practice. Where all members commit to a single set of values and beliefs this can afford a unique identity, reinforced by the ability to demonstrate and articulate this through a clear, single message.

The Next Paradigm Shift in Occupational Therapy Education: The Move to the Entry-Level Clinical Doctorate

The occupational therapy profession in the United States is considering another shift in the level of entry-to-practice education. Currently, all accredited U.S. occupational therapy education programs offer graduate-entry master's degrees or clinical doctorates. In 2014, the American Occupational Therapy Association Board of Directors published a position statement supporting the idea of moving all entry-level occupational therapy education programs to the clinical doctorate level by 2025. This article provides an overview of the proposed reasons for doing so and the potential impact of this move on future students, education providers, clients and families, employers, and third-party payers and funding bodies along with the implications for the occupational therapy profession internationally. An open, informed, transparent, multiperspective, comprehensive debate about this education paradigm shift is recommended. In August 2015 the Accreditation Council for Occupational Therapy Education decided that the entry-level qualification will remain at both the master's and the doctoral degree; it is anticipated, however, that the move toward the entry-level clinical doctorate will continue.

Exploring emerging occupational therapy identity and the development of graduate attributes among occupational therapy students

Introduction

Strong professional identity allows for appropriate representation and promotion of occupational therapy. Academic education assists in the development of occupational therapy identity. This study aims to explore the development of occupational therapy identity and graduate attributes in occupational therapy students after the first year of a revised curriculum.

Method

Occupational therapy students ( n = 58) were surveyed at the commencement of the second year. Data analysis used descriptive statistics and inferential statistics (χ2 for trend).

Results

A total of 54 students (93.1%) completed the survey. Students progressively developed occupational therapy identity over time. There were no significant associations between main factors influencing the original decision to study occupational therapy and when occupational therapy identity developed. However, there were significant associations between main factors influencing students' decision to continue studying and when identity developed. Most students agreed the curriculum equipped them to develop graduate attributes, although this was not significantly associated with factors that either influenced students to study, or continue studying, occupational therapy. There was significant association between development of graduate attributes and occupational therapy identity over time.

Conclusion

This study showed an emergence of occupational therapy identity and graduate attributes in students, demonstrating the importance of first year curriculum in the development of these factors.

WOW! Occupational therapy education and experiential service learning through community volunteering

Introduction

This research investigated the contribution of ‘Widening Occupation Weeks’, a two-week experience of occupation-focused service learning through community volunteering, to undergraduate occupational therapy education.

Method

A pluralist research methodology combining psychosocial approaches with cooperative appreciative inquiry and grounded theory was used in order to explore individual experiences and collective understanding. Students participated in questionnaires and a focus group to: explore how Widening Occupation Weeks impacted on understanding of the relationship between occupation, health and wellbeing; discover students’ interpretation of significant learning; develop a general view of the relevance of Widening Occupation Weeks for occupational therapy education.

Results

Thematic analysis of qualitative data identified that students’ experience during Widening Occupation Weeks is diverse and variable, enabling learning about the occupational therapy paradigm and about the values involved in being a therapist: therapeutic relationships and professionalism. Significant learning occurs through reflection over time on the challenging, contrasting experiences offered by the Widening Occupation Weeks model. This contributes to the development of personal theories of practice, recognised as a key component in professional socialisation and innovation.

Conclusion

The pluralist methodology enabled perspectives on personal and collective interpretation of learning and the findings can be translated to a general theory about the value of occupation-focused, service learning in occupational therapy education.

Evaluating the Impact of Audits and Feedback as Methods for Implementation of Evidence in Stroke Rehabilitation

Introduction:

This paper evaluates audits and feedback as methods to increase implementation of evidence in stroke rehabilitation.

Method:

The study used an action research approach and theories of knowledge translation. A sample of 22 occupational therapists participated from two Danish hospitals that admitted stroke patients. Data collection methods included audits of occupational therapy medical records, documentations of daily practice, and collaborative discussions. Active feedback and discussions of the findings took place, at a group level in four local clinical audits. Data analysis of daily self-reported recordings and audits was descriptive. Audit data were analysed using descriptive statistics. A phenomenological hermeneutical interpretive methodology was used for analysing qualitative data.

Findings:

Audits and feedback were based on clear standards and contextual developing action plans. Daily practice in both settings adapted to the clinical guidelines. Implementations of the standardized assessment tools seemed to be the most successful.

Conclusion:

The effects of audit and feedback profited from the active participation of the therapists, as well as local gatekeepers having formal responsibilities for implementing change. The process was strengthened by providing the audits and feedback more than once. The effect of audits and feedback was positively influenced by being in line with current conceptual frameworks, local policies, and values.

Living tensions: reconstructing notions of professionalism in occupational therapy

BACKGROUND/AIM

Reform of health organisations has brought significant changes to healthcare systems with attendant consequences for the definition and practice of professionalism. Occupational therapists must continually strive to provide excellent patient care, delivering positive patient outcomes whilst responding effectively to increasing fiscal constraint and changing organisational paradigms. This paper explores the experiences of occupational therapists as they reconstruct professionalism as a consequence of health care reform in England.

METHOD

Fourteen occupational therapists were interviewed over 12 months across five National Health Service organisations in England. Each participant was interviewed three times and was asked to keep a monthly diary of critical incidents. A process of narrative analysis was developed to analyse these data.

RESULTS

Findings suggest that changes have occurred in the National Health Service which affects notions of professional values, expertise, status and accountability. However, far from seeing themselves as mere responders to stimuli, occupational therapists tell of mediating policies, of responding, experimenting and redefining choices whilst struggling to reconstruct professionalism.

CONCLUSIONS

It is suggested that professionalism can be conceived as a reflexive ethical concept in that it is through the process of reflecting on the discursive and behavioural options and values available that occupational therapists come to understand, and define their professional selves.

Problem-Based Learning Students' Perceptions of Knowledge and Professional Identity: Occupational Therapists as ‘Knowers’

Purpose:

The future of occupational therapy is dependent on profession-specific knowledge to underpin its practice. This research explored occupational therapy students' perceptions of knowledge and their professional identity from one problem-based learning programme.

Procedure:

A qualitative methodology using in-depth interviews gathered data from 20 occupational therapy students in their final year of an undergraduate programme. The data were analysed thematically and in relation to theoretical constructs derived from the sociologists of education, Basil Bernstein and Karl Maton.

Findings:

The students viewed occupational therapists as ‘knowers’ rather than as ‘knowledgeable’ therapists. This distinction is embedded in a professional identity grounded in the dispositions of the occupational therapist and the philosophical constructs that support occupational therapy, but not in the specialist knowledge of occupation.

Conclusion:

The students' experiences suggest that the problem-based learning programme provides the transferable skills and philosophical constructs that allow them to practise in a diverse range of contemporary occupational therapy settings. However, simply mirroring current practice restricts professional advancement. The identity of the occupational therapist needs to embrace both a philosophical discourse and the specialist knowledge of occupation.

Critical reflections on school-based occupational therapy

This article describes the process of facilitating change to practice that is more client-centered and occupation-based in a diverse suburban public school district in the USA from 2001 to 2006. The author sets the context, describes the process that included the use of the School AMPS, and considers factors that facilitated and constrained change.

Role-Emerging Placements are an Essential Risk for the Development of the Occupational Therapy Profession: The Debate

There is an increasing awareness of the use of role-emerging placements within occupational therapy education. A greater number of higher education institutions are recognising the value of their students undertaking at least one of their practice placements within a role-emerging setting. Similarly, students are developing a sense of the depth of the learning experience that can be gained from these placements. However, with these developments are the inevitable challenges, posed to academic staff, students, clinicians, staff within the voluntary sector and the profession as a whole. This opinion piece discusses both the challenges and the opportunities posed by the increasing use of role-emerging placements within the United Kingdom, and whether or not role-emerging placements are actually essential to the development of the profession.