A Student’s Guide to Using AJOT for Fieldwork (and Beyond)
In my first week as a Level II fieldwork student, I felt confident. Too confident, as I would soon find out.
From the corner of patients’ rooms at a small inpatient rehab hospital, I observed my fieldwork educator (FWE) as she went about treating patients and I thought to myself, I can do that, no problem. I acted as her “gopher,” running to the supply closet for ADL supplies. I did my best to anticipate her needs, handing her a brief or a reacher. I jumped in when I thought it was appropriate and assisted with transfers. I built rapport with patients, doing my best to make them laugh, feel comfortable. These interactions felt natural and reminded me of my time as a bartender when I would gab and gossip with my customers.
But when the time came for my FWE to kick me out of the proverbial nest and for me to lead treatment sessions, I was plummeting to earth. Every time I entered a patient’s room, my stomach dropped. I would often freeze in place, unsure as to what to do next. I was, I thought at the time, completely out of my depth. It was as if all the training provided by my long-suffering professor in her adult intervention and clinical reasoning courses simply vanished into thin air.
Cue the Imposter Syndrome, returning louder and stronger than ever.
As my caseload increased, so did it seem the complexity of my patients’ conditions. Many of the patients I was treating had experienced a stroke, with varying degrees of severity. And then there were the patients who had experienced cardiac episodes, a few of whom were attached to equipment I was unfamiliar with. The number of contraindications seemed staggering.
And so, in that second week of FW, began the “search.”
First, I should say that before this FW rotation began, I had—like any good prospective FW student—performed a general review of the conditions, assessments, and interventions recommended by my FWE. But now, faced with an ever-increasing caseload, I was nightly opening a simply outrageous number of tabs on Google Chrome, while in adjacent windows floated a smattering of PowerPoints and my online textbooks. And while certain textbooks continue to be invaluable, they might be several years old and lack emerging best practices.
If you’re like me, you may tend to go down rabbit holes when performing searches. In my first career as a writer and research assistant, I would often go to the many public libraries in New York. My clients, mostly authors of historical non-fiction, required sources for their projects that were often unavailable online. In the beginning of my searches, I would often find my eyes glazing over at the sheer volume of results—complete with Dewey Decimal numbers—that popped up on the library computer. But eventually, by applying what I learned from the saint-like librarians in Brooklyn and Manhattan, I began to narrow results and locate sources more easily and quickly.
But this FW experience was something altogether different. Not only was I overwhelmed by the search results, but I also didn’t know where to start, what was worth reading in-depth. To raise the stakes even more, I was acutely aware that the interventions I ultimately chose for my patients had real-life consequences for their future well-being.
That’s when I turned to the American Occupational Therapy Association (www.aota.org) and American Journal of Occupational Therapy (AJOT) (https://research.aota.org/ajot) websites. And this is where I found the Stroke Practice Guidelines and contemporary articles that outlined emerging best practices for stroke survivors, which was a perfect launching pad for more specific searches.
One of the many great things about AJOT is the addition—as of Volume 78 (2024)—of “plain-language summaries,” which you can find at the top of an article (it’s the last paragraph in the abstract). These summaries replaced the “What This Article Adds” and for me, have been a game changer, not to mention a time saver. Even more so than the abstract, the summaries digest often dense material into condensed, easy-to-understand language. I can now click an article and quickly decide if it is worth my time and energy.
Furthermore, once you have clicked on an article, on the right-hand side of the page you will see a link symbol for related articles. This is another way of refining your search quickly or discovering articles that you may have otherwise missed. If you have an AOTA account, you can even save your search and create an alert that will email you when new content is published that matches your search.
By using AJOT and AOTA resources, I had a new lens through which to understand my patients’ conditions and how to best treat them. This is, of course, only half the battle. I could read and synthesize all the research in the world, but it wouldn’t mean very much to the patient if I didn’t first build rapport and collaborate with them to better understand their goals and what motivates them.
Case in point: one of my patients—I’ll call him Mark—had recently experienced a second stroke. After the first stroke, he had been able to transfer himself from bed into his wheelchair. Now, however, Mark required maximal assistance to complete the transfer. His trunk support had also decreased, and he leaned to one side while seated in his wheelchair.
From day one of our more than 2 weeks together, Mark and I had an “unpredictable” relationship. One day he was eager to get out of his room and into the gym with me, the next he was dismissing every idea I suggested, swatting me away like a fly. On those latter days, I left treatment with him feeling like a failure.
What was consistent was Mark’s noncommittal attitude about his goals. He would only shrug slightly when I asked him what he hoped to get out of therapy. I tried to be patient and not take it personally, realizing that part of Mark’s emotional lability could be attributed to having experienced the trauma of a second stroke and being in a hospital. And so, undeterred, I consulted articles that seemed to align with his current condition. The next day, feeling proud of myself, I went to Mark’s room for treatment. Despite providing him with a summary of my research, he was—unsurprisingly—not eager to try out any of my ideas. Fortunately, this became one of many teaching moments, as it quickly dawned on me that I had been arrogant and let my ego get in the way, that what I was suggesting did not connect with him or his goals for returning home. He wasn’t necessarily interested in becoming more independent, because he had people at home who assisted him. In a rare, unguarded moment, he told me about how he enjoyed lifting his free-weights at home while listening to music or watching football. Moving forward I began to provide him with other options, ones that I hoped would motivate him, such as light upper body exercises while he was seated in his wheelchair . Now, not only was he doing something he enjoyed at home for leisure and exercise, but he was also participating in therapy and strengthening his upper body, something that could prepare him to participate more actively in transfers in the future.
By the time of his discharge, our therapeutic relationship had improved. I’m not sure if it was because I wore him down or gained his trust. I was nothing if not persistent. When I saw him watching football one day in his room, I ever-so-casually asked him about his favorite team and surprised him by naming players long retired. Our conversation became a “who’s who” of Nineties NFLers. When he left the hospital with his son, I felt grateful for Mark and confident that he had the support at home to be safe.
On the flip side of my experience with Mark was Ruth, a patient I immediately hit it off with. Ruth and I were, in a word, simpatico. We were both self-deprecating and easily amused. We both liked to cook and traded recipes. I left treatment with Ruth with a smile on my face, feeling like I was exactly where I belonged. Ruth was also very motivated and clear about her goals. In our first session in the therapy gym, she told me she would do whatever it took to improve the range of motion in her left upper extremity, explaining that she was the primary caregiver to a family member and needed to be able to assist them with everything from dressing and bathing, to feeding and toileting. That day we met she required almost maximal assistance to dress herself.
As I had done for Mark, I searched AJOT and pored over a systematic review on upper extremity recovery. Ruth and I discussed it the next day and refined our plan. She improved quickly, making considerable gains in her proximal left upper extremity. That said, during her stay, she continued to struggle–and grow frustrated–with fine motor tasks such as turning a key in a doorknob Wanting to give Ruth options, I made suggestions for different fine motor tasks moving forward, but she asked, somewhat sheepishly, as if she were worried she would hurt my feelings, if we could try something else the next day.
In school, we had learned that mirror therapy had been shown to ease the pain and discomfort in individuals with phantom limb pain. But I recalled a guest professor mentioning that it was also applied to individuals with stroke. In the systematic review, the authors had mentioned that, in conjunction with task-oriented training, mirror therapy had been shown to be effective (Lee and Howe, 2024). The next day I summarized for Ruth what I’d found. She had actually heard of mirror therapy and was excited to try it.
After consulting with my FWE, we set up a mirror at a table in the therapy gym. While seated, Ruth began to perform simple active range of motion exercises with her unaffected hand in front of the mirror while she tried to mimic the exercises with her affected hand, which was on the other side of the mirror, outside her field of vision. Other patients in the therapy gym craned their necks from their wheelchairs and walkers to see what she was doing. “It’s so strange” she whispered, almost in disbelief. Soon enough, I observed improvements when she practiced fine motor tasks. Before she was discharged, she proudly told me that she had put on her bra that morning without any help.
Conclusion
The truth is, research literature is at times intimidating. As a clinician shared with me recently, engaging with research is a skill that requires practice. Where do you start? Do you cast a wide net with your search and risk falling into a rabbit hole? Or do you maintain a narrow focus and potentially miss something that might be useful? But here’s the thing: it doesn’t have to be intimidating. Plain-language summaries, suggested articles, best practice guidelines, systematic and scoping reviews—all these features help you hone your search and, again, save you precious time. More importantly, the benefits to your patients, their caregivers, and to you as a student or clinician are numerous.
There is an article about evidence-based practice that I came across when I was providing an in-service during my Level II fieldwork. The study, published in AJOT, found that “[i]mplementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists” (Bar-Nizan et al., 2024). Understandably, and to deliberately sound like a broken record, further research on this topic is needed. Furthermore, as I learned from my interviews with clinicians for my doctoral capstone, there are many barriers that clinicians face to engaging with research literature, from limited time due to high productivity standards to lack of access to resources in their practice settings. But by providing clinicians with the time and resources to engage with research, hospitals and clinics can ensure a mutually beneficial relationship. This may sound naïve, but I can’t help but think that by utilizing more evidence-based resources, such as those provided by AOTA and AJOT, occupational therapy practitioners will be more fulfilled, challenged, and inspired; their passion for OT rekindled; and their patients and clients all the better for it.
References
Bar-Nizan, T., Rand, D., & Lahav, R. (2024). Implementation of evidence-based practice and burnout among occupational therapists: The role of self-efficacy. American Journal of Occupational Therapy, 78, 801205190. https://doi.org/10.5014/ajot.2024.050426
Lee, C., & Howe, T. (2024). Effectiveness of activity-based task-oriented training on upper extremity recovery for adults with stroke: A systematic review. American Journal of Occupational Therapy, 78 7802180070. https://doi.org/10.5014/ajot.2024.050391
Patrick Callihan grew up in Memphis, TN. In 2007, he moved to New York where he earned his MFA in writing from the New School. After working as a freelance research assistant and bartender, Patrick discovered and fell in love with OT. In May of 2025, he graduated from Virginia Commonwealth University's OTD program. His professional interests include stroke and mental health.