occupational therapy in poland in the context of world and

occupational therapy in poland in the context of world and

Review
OCCUPATIONAL THERAPY
IN POLAND IN THE CONTEXT
OF WORLD AND EUROPEAN
EDUCATIONAL STANDARDS
AND QUALIFICATION
FRAMEWORKS
TERAPIA ZAJĘCIOWA W POLSCE
W KONTEKŚCIE ŚWIATOWYCH
I EUROPEJSKICH STANDARDÓW KSZTAŁCENIA
ORAZ RAM KWALIFIKACJI ZAWODOWYCH
Natalia Morgulec-Adamowicz, M. D.,Ph. D.(A,B,D,E,F)
Józef Piłsudski University of Physical Education in Warsaw, Faculty of Rehabilitation,
Department of Adapted Physical Activity
Correspondence:
Natalia Morgulec-Adamowicz, M. D., Ph. D.
Marymoncka Str., No 34, Warsaw, Poland,
e-mail: [email protected],
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Polish Journal of Rehabilitation Research
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ABSTRACT
An important recent element of European education policy is the development of a Vocational Qualifications Framework. It is intended to provide a high
quality education in the European Higher Education Area (EHEA), increase
employability and improve the competitiveness and attractiveness of European higher educational systems in the world. In the field of occupational therapy, educational standards have been developed by the World Federation of
Occupational Therapy (WFOT).
The aim of this study was to analyze the present educational system of occupational therapists in Poland in the context of world and European educational standards and qualification frameworks. The most common training for
occupational therapists in Poland differs from WFOT standards in terms of learning outcomes. A comparison of WFOT standards and recommendations
of European Network of Occupational Therapy in Higher Education (ENOTHE) and Council of Occupational Therapists for the European Countries
(COTEC) with the Polish training system for occupational therapists has confirmed the need for development. The future development of Occupational
Therapy may depend on establishing a professional organization which will
develop and promote occupational therapy in Poland and cooperate with organizations representing other members of therapeutic teams.
Key words: occupational therapy, qualification frameworks, learning outcomes,
standards of education
STRESZCZENIE
W ostatnich latach ważnym elementem europejskiej polityki edukacyjnej jest
tworzenie ram kwalifikacji zawodowych. Mają one zapewnić porównywalność jakości procesu kształcenia w Europejskim Obszarze Szkolnictwa Wyższego (EHEA), zwiększyć szanse na zatrudnienie oraz poprawić
konkurencyjność i atrakcyjność europejskich systemów szkolnictwa wyższego
w skali światowej. W dziedzinie terapii zajęciowej standardy kształcenia opracowane zostały przez Światową Federację Terapeutów Zajęciowych (WFOT).
Celem poniższej pracy była analiza obecnego systemu kształcenia terapeutów
zajęciowych w Polsce oraz odniesienie standardów kształcenia WFOT do koncepcji europejskich i Krajowych Ram Kwalifikacji w kontekście polskiego systemu kształcenia, ze szczególnym uwzględnieniem szkolnictwa wyższego.
Najpowszechniejsza dotychczas w Polsce forma kształcenia terapeutów zaję-
ciowych, prowadzona w ramach klasyfikacji zawodów szkolnictwa zawodowego, odbiega pod względem efektów uczenia się od standardów WFOT.
Analiza standardów kształcenia WFOT, wytycznych Europejskiej Sieci Terapii
Zajęciowej w Szkolnictwie Wyższym (ENOTHE) i Rady Terapii Zajęciowej
Krajów Europejskich (COTEC), oraz polskiego systemu kształcenia terapeutów zajęciowych uzasadnia potrzebę wprowadzenia kierunku studiów – terapia zajęciowa. Dalszy rozwój terapii zajęciowej w Polsce wymaga powstania
organizacji zawodowej dbającej o rozwój (w tym oddziaływania na tworzenie
odpowiednich regulacji prawnych) i promocję w naszym kraju, a także współdziałającej z organizacjami reprezentującymi interesy pozostałych członków
zespołu terapeutycznego.
Słowa kluczowe: terapia zajęciowa, ramy kwalifikacji, efekty uczenia się, standardy kształcenia
The paper is based on research funded by the project called
"Improvement of teaching and research potentials in the field
of occupational therapy as the key to the development of
higher education," part-financed by the European Union
under the European Social Fund.
medical rehabilitation departments and sanatoriums. Since the
beginning of the ‘90’s, OT has been also practised as part of the
Occupational Therapy Workshops, which were set up following
the Employment and Vocational Rehabilitation of Disabled People Act of 1991 [3] and later regulations of the Ministry of Labour and Social Policy [4].
As Occupational Therapy is one of professions taught as part
of the common educational system, it is listed both in the Vocational Education Classification (VEC) [org: Klasyfikacja zawodowa szkolnictwa zawodowego] described in the
Regulations of the Ministry of National Education dated 26 June 2007 [5] and in the Classification of Professions
and Specialties (CPS) listed in the regulations of the Ministry of Labour and Social Policy dated 27 April 2010 [6]. In
the VEC, occupational therapy (code: 322 [15]) is part of the
mid-level medical staff [5], while in CPS, occupational therapy (code:) is the mid-level medical staff unclassified anywhere else [6]. The education of occupational therapists is
organised in postsecondary vocational schools [7]. Hence, the
occupational therapist is a graduate of either a post-primary1
or post-secondary2 school (general secondary school, supple-
Occupational therapy (OT), also called therapy through occupation and/or ergotherapy, refers to various activities which are
prescribed to patients as treatments aiming to quicken the return of a lost function of the locomotor system and, in the case
of irreversible damage, to trigger substitute functions [1]. The
value of occupation and work as treatments were already known
to ancient doctors: Asclepiades, Soranus, Cornelius Celsus, Hippocrates, Claudius Galenus and others [2]. Between the 18th and
19th century, Dr Philippe Pinel, the author of „moral treatment”,
introduced OT to hospitals for the mentally ill in France [2].
After World War I, OT became one of the main ways of quickening the process of returning to physical fitness after the locomotor system had been damaged [2]. In Poland, OT has emerged
between the 19th and 20th century, but its real development occurred after World War II alongside psychiatric, tuberculosis and
1
2
Before the introduction of the school system reform (Journal of Laws from 1999, No. 12, item 96)
After the introduction of the school system reform (Journal of Laws from 1999, No. 12, item 96)
Polish Journal of Rehabilitation Research
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mental general secondary school, profiled secondary school,
vocational secondary school or supplemental vocational secondary school), but has not necessarily graduated with a secondary school certificate. Education in this profession
takes 2 years. Its programme, division into modules and their content, are described in detail in the occupational therapist education programme found in the regulations of the
Ministry of National Education and Sport (2005) [7].
The 2010 regulations of the Ministry of National Education
[8] set out the requirements for awarding occupational therapy qualifications. The examination not only verifies professional skills and knowledge (part I) but also skills and
knowledge regarding employment and conducting economic
activity (part II). Alternatively, an occupational therapist can
be a graduate of a university with a batchelor's and/or master’s degree from a course specialising in OT with at least 3000 hours of classes, including 2000 hours in the basic
and professional contents group encompassing knowledge
from both theory and therapeutic techniques [9]. Since OT is
not found on the list of 118 majors included in the regulation
of the Ministry of Science and Higher Education from 2006
[10], no standards of education for occupational therapists
exist for first and second cycle education levels (bachelor and
master degree). In Poland, apart from the majority of occupational therapist courses conducted in post-secondary schools, there are also post-graduate courses in the field or
specialisations, usually as part of special pedagogy at bachelor and master degree. In most European countries, occupational therapists have separate majors [12] in accordance with
recommendations of the World Federation of Occupational
Therapists (WFOT) [11].
The project „Improving the Didactic and Scientific Potential of Occupational Therapy as the Key to the Development of
Colleges and Universities”3, carried out in Poland between 2009 and 2012, marked the beginning of an alignment of
the Polish system of training occupational therapists with the
standards of other European countries, set out by the WFOT,
ENOTHE (European Network of Occupational Therapy in
Higher Education) and COTEC (Council of Occupational
Therapists for the European Countries). The aim of this article is to review the present state of occupational therapist training in Poland and its qualification framework in the context
of the Polish educational system, and compare it with WFOT
and ENOTHE educational standards, with a special emphasis
on higher education.
In recent years, developing a common Framework for Qualifications of the European Higher Education Area, a part of the
European Qualification Framework (EQF), has become an important element of European educational policy. By enabling
comparisons to be made between different qualifications, the
aim of the EQF is to ensure a high quality of education within
the European Higher Education Area (EHEA), improve chances of employment and mobility of employees, as well as to improve the competitiveness and attractiveness of the European
Higher Education systems when compared to the rest of the
world [13]. An important part of the formulation of the EQF
is made up of the recommendations of both domestic and international professional organisations [14]. In addition, the
National Qualification Framework (NQF) should be adjusted
to standards of education in the particular field, taking into
account the cultural context and the formal4, non-formal5 and
informal6 education that goes with it [15, 16]. The concept of
the NQF set out in the Higher Education Act [17] enables universities and colleges to create new majors [14], which is described in detail in the 2011 directive of the Ministry of
Education concerning the conditions of offering majors based
on specialisation and cycle of studies [18]. It is now possible to
create a new major in OT, defined by an educational programme. The programme should consist of two parts: a description
of intended learning outcomes and a description of the process which should lead to achieving them [18, 19].
Figure 1. Components of the Occupational Therapist Educational
Programme recommended by WFOT [11]
Project co-financed by the European Social Fund, as part of Human Capital Operational Programme (priority IV – Higher Education and Science), carried out by the University
School of Physical Education in Cracow, University School of Physical Education in Wroclaw, Higher School of Administration in Bielsko-Biała, Józef Piłsudski University of
Physical Education in Warsaw and the Association “Education for Entrepreneurship”.
4 Is delivered through programmes carried out in schools, universities, colleges and others, after which one acquires qualifications with a qualification awarded at the end [16]
5 Does not lead directly to acquiring qualifications. Is carried out as part of programmes organised by different institutions (e.g. employers, civic organisation, but also colleges and
universities, schools and individuals) [16]
6 Acquiring new competence without the use of programmes carried out by institutions educating/training (without a teacher/instructor/coach), through individual activity aiming at
reaching defined learning goals and/or through unintentional learning [16]
3
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In the „Revised minimum standards for the education of occupational therapists”, WFOT mentions 3- and 4-year occupational therapy educational programmes connected with
academic education cycles [11]. The WFOT guidelines on designing programmes are described using terminology similar
to the one that used in NQF [16, 20]. The programme is defined by learning outcomes, that is, the knowledge, skills and social
competencies/attitudes of the occupational therapist (figure 1).
According to WFOT recommendations, programme design
should start with an analysis of local determinants, such as
the need for healthcare (epidemic data, population trends, health status of different social groups, and other factors), legal
regulations (regarding the structure and organisation of the
healthcare system, social care, education and employment,
health insurance, health promotion, non-governmental organisations, and others), the occupations of the OT (value, importance and type of occupations in a cultural and economic
context, with gender and age also taken into account) and the
history of OT (the present status of OTs, professional associations, services offered as part of occupational therapy, regulations regarding the profession of an OT). The knowledge of
the local determinants, mentioned above, should be reflected
in the educational programme, so that a qualified OT can to
meet the needs of the local community [11].
Before the programme can be drawn up, separate entry requirements for potential candidates for 1st, 2nd and 3rd cycle of
OT studies should be laid out. In the WFOT programme, the
qualifications (knowledge, skills and social competences) of
future occupational therapists were divided into five areas
concerning (I) the relationship between person-environment-occupation model and health (detailed competences related
to: occupation, person, environment and job-health relationship); (II) therapeutic and professional relations (detailed
competences related to: relationship with the recipients of the
OT and relationship with the therapeutic team); (III) the process of occupational therapy; (IV) professional inference and
behaviour (detailed competence related to: the process of conducting research and gathering information, ethical behaviour, professional qualifications, practice based on reflection
and management) and (V) the context of professional practice [11]. The recommended structure of the „minimum standards for the education of occupational therapists”
incorporates six aspects related to the goals and philosophy of
the programme, the content of the syllabus, teaching methods, student practices, teaching staff, equipment and resources [11]. Each of the above aspects is precisely characterised
by five criteria, which are also the criteria used for WFOT accreditation (Tab. 1).
When the occupational therapist training programmes are
compared, two aspects seem of crucial importance: – the content of the syllabus and student practices. WFOT recommends
that at least 60% of the programme should be connected with
OT, of which a minimum of 1000 hours should be practical
Table 1. Criteria used for the evaluation of the minimum
programme requirements in OT training, according to WFOT [11]
Criterion
Criterion Description
Congruence
Programme congruent (knowledge, skills and
social competence) with local context
Depth and Breadth
Range, depth and breadth.
Local Context
The meaning and relation with the local context.
International
Perspective
Compliance with expectations of the
international society of occupational therapist
and international ways of thinking about health
and education.
Quality Improvement Mechanism of constant quality improvement.
work. About 10-30% of course time should be spent on the basics of biomedicine related to the structure of the body and its
functions, and the remainder should be spent on social aspects
of health [11].
ENOTHE and COTEC, as part of the TUNING Educational Structures in Europe project carried out between 2004 and
2008, developed an exemplary model of OT education for 1st,
2nd and 3rd cycle of studies, compliant with the Qualifications
Framework for the European Higher Education Area [20]. The
development of an OT programme is based on eight elements:
(1) basic conditions (identification of social demand on regional, national and international levels, with the opinion of professional associations also taken into account; evoking interest
in the programme among academics; availability of essential
resources – equipment and staff), (2) defining the profile of the
program, (3) description of the program’s goals in terms of learning outcomes (knowledge, skills and social competence),
(4) identification of generic and subject-specific competence,
(5) writing competence into the programme through contents
and structure (modules and scoring points), (6) division into
units of education (lectures, seminars, workshops, etc.) (7) setting out methods, techniques, and forms of teaching, learning
and evaluation, (8) setting a coherent and comprehensive system of evaluation, ensuring constant education quality improvement [20]. Competences are a combination of cognitive and
metacognitive skills, knowledge and its understanding, interpersonal, intellectual and practical skills, as well as ethical values [21]. Generic competences, be they general instrumental,
interpersonal or systemic, are common to all major programmes (competences are general instrumental, interpersonal or
systemic), whereas subject-specific competences are strictly
connected with a particular major. In the TUNING project,
the specific competences for the three cycles of studies were
divided into six groups: (1) knowledge of OT; (2) OT processes and professional reasoning; (3) professional relationships
and partnerships; (4) professional autonomy and accountability; (5) research and development in OT and Science; and (6)
management and promotion in OT [20]. A student’s work,
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expressed in ECTS7 points, should equal between 180 and 240
for 1st cycle of study, 90–120 for 2nd cycle of study, and a minimum of 180 for level 3rd cycle of study [20].
The basis of a 2-year OT educational programme in Poland
is composed of (I) programme and organisation standards of
education in the OT profession, (II) division of hours into programme modules and (III) characteristics of the programme
blocks [7]. In the programme and organisation standards section, the professional qualifications of an OT are set out, along
with the necessary specific education requirements: psychophysical requirements specific for that profession; scope of
professional tasks; place of employment; equipment available
in the school educating OTs; division of skills and programme
contents into topic modules [7]. Table 2 shows the division of
hours into programme modules. Each of the programme modules is characterised both in terms of goals (described as learning outcomes) and contents of education [7].
Table 2. Division of hours into programme modules in a 2-year
OT course in Poland [7]
Name of the programme module
Minimum number of hours
during education in (%)*
Rehabilitation
13
Occupational therapy
45
Basics of professional activity
34
Basics of law and economics in
healthcare and social care
Sum
3
95**
* The division into programme modules applies only to secondary
education,
** The remaining 5% of hours is for the authors of the educational programmes to fill as they wish, according to local job market needs.
The preparation and implementation of the Qualifications
Framework into the Polish educational system is the job of the
National Qualification Framework Steering Committee for lifelong learning, established on the basis of a directive by the
Prime Minister dated 17 February 2010 [22]. One of the tasks
of the committee was to develop a description of learning outcomes for a general academic profile and a practical profile
in 9 areas of education. OT training will be reside in two areas: 1) medical sciences, health sciences and physical culture
sciences, and 2) social sciences. These „area learning outcomes” were accepted by the Ministry of Education on 2nd November 2011 [23]. According to the Higher Education Act [17]
a basic organisational unit of a university/college with the right to grant the title of Habilitated Doctor and meeting the
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conditions listed in regulations introduced on the basis of article 9 section 3 point 1 [17], can establish a major, of a type
and cycle of study decided by the university/college Senate,
through a resolution, as part of educational areas and disciplines corresponding to the rights of the university/college to
grant the aforementioned title. The senate resolution sets out
the learning outcomes, and then creates the course plans and
educational programmes, appropriate to the cycle of study and
profile of education, which are fitted to these learning outcomes. Therefore, it can be assumed that universities/colleges
meeting the above mentioned conditions, and the conditions
regarding the Area Learning Outcomes for medical, health
and physical culture sciences listed in the regulations of the
Ministry of Science and Higher Education [18], based on Area
Learning Outcomes for medical, health and physical culture
sciences, will be eligible to create an OT major on lst and 2nd
cycle of studies. As one of the conditions of offering a particular major [18] is to incorporate international education standards when designing the programme, therefore the analyses
of WFOT, ENOTHE and COTEC educational standards are
recommended in this case.
Introducing an OT major in Poland is an important step in
the development of the profession and a considerable challenge for universities and colleges. Even more importantly, according to the recommendations of the European Parliament and
European Council [13, 24], universities and colleges will have
to develop a system of validation and recognition of informal
and non-formal OT education, as well as awarding credits for
learning outcomes gained outside the formal educational system, through professional experience, hobby or individual
work. It seems, though, that the key to further development of
OT will be changes in legislation. If appropriate regulations
do not specify rules and conditions of practising OT, including
cycle of education, then the OT major may prove a marginal
and niche course.
A similar situation was observed in the case of nursing in the
‘70s and ‘80s, when there were nursing departments in medical academies, but there was little interest in them, because
a licence to practise nursing could be obtained by graduating
from a medical secondary school, a medical post-secondary vocational course or a medical post-secondary school. It was not
until the ‘90’s, when the system of educating nurses in Poland
had been adjusted to EU standards, that it became common
and obligatory to educate nurses through higher education.
Hence, it seems necessary to establish a professional organisation to develop (and co-author appropriate legislation) and
promote OT in Poland, but also cooperate with organisations
representing the interests of the other members of the therapeutic team: physiotherapists, doctors, nurses, social workers,
psychologists, special pedagogists and others, depending on
European Credit Transfer and Accumulation System – a student’s work during one academic year of a full-time major, equals 60 ECTS points. In most cases, a student of a full-time major
in Europe works about 1500-1800 hours a year, so 1 ECTS point is about 25-30 hours of work [21].
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the needs. It will be also necessary to give an opportunity to the
OTs already working to enrich their qualifications. On the
other hand, the organisations should also ensure compliance
of OT training in Poland with WFOT, ENOTHE and COTEC
educational standards. The above measures should lead to definingthe scope of competence of an OT, which would be clear
for both the therapeutic team and employers.
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