Purpose: Reflective practitioners embody the ability to critique their own clinical thinking about the dilemmas that frequently arise in professional practice and everyday life. Conflicting evidence exists on whether or not self-reflective practices are effective in promoting academic, clinical, and personal success. This quantitative study investigated self-reflection as a predictor of increased occupational competence and clinical performance in Level II Fieldwork for entry-level Master's degree occupational therapy students. Method: The study used convenience sampling to recruit participants and data were collected via a demographic survey and self-assessment questionnaires. Multiple linear regression analyses were conducted to determine the extent to which self-reflection predicts occupational competence and clinical performance. R2 values were examined to determine the importance of each dependent variable (occupational competence and clinical performance). Results: Findings revealed a statistically significant relationship between self-reflection and occupational competence (p = 0.0053) but not between self-reflection and clinical performance (p = 0.08). Self-reflection accounted for 14% of the variance in clinical performance (R2 = 0.14), and more than one third (R2 = 0.38) of the variance in occupational competence. Results suggest that students who self-reflect regularly during fieldwork may have a greater ability to maintain everyday life routines during the demands of Level II Fieldwork. Conclusions: Self-reflection strongly predicts occupational competence of occupational therapy students during Level II Fieldwork, but does not significantly predict students’ clinical performance. Recommendations: Occupational therapy educators should consider incorporating guided self-reflection activities into the academic program in order to support student occupational competence. Intentional coaching in self-reflection may better prepare students for a clinical setting by supporting healthy daily routines, which may help them to manage stress during Level II Fieldwork. Future research should explore the impact of self-reflection training during clinical rotations (provided by clinical educators) on student clinical performance. Revision of the measurement of clinical performance is warranted to include questions pertaining to soft skills such as self-reflection and awareness.

Author Bio(s)

Susan L. Iliff, Ph.D., M.S., OTR/L is an Assistant Professor at Belmont University. She has practiced occupational therapy for over twenty years in pediatric and community-based settings. Her research interests include learning and teaching strategies, pediatrics, and international global health service.

Gaylene M. Tool, MOT, OTR/L is a licensed occupational therapist with the state of New Mexico providing service in rural communities. She is a guest lecturer for the University of New Mexico’s occupational therapy program.

Patricia Bowyer, EdD, M.S., OTR, FAOTA is Doctoral Programs Coordinator, Professor and Senior Scientist at Texas Woman’s University, School of Occupational Therapy-Houston. Her research focuses on increasing life participation for people with disabilities through the development of theory-based assessments and interventions based on the Model of Human Occupation.

L. Diane Parham, Ph.D., OTR/L, FAOTA is a Professor in the Occupational Therapy Graduate Program at the University of New Mexico. She has over 30 years of experience in occupational therapy education. Her publications include an article on reflective practitioners, and seven articles that address occupational therapy in academia.

Tina Fletcher, Ed.D., MFA, OTR is an Associate Professor of Occupational Therapy at the T. Boone Pickens Institute of Health Sciences at Texas Woman’s University in Dallas, Texas. Her areas of research entail well-being, creative expression, and community participation.

Wyona M. Freysteinson, Ph.D., MN is an Associate Professor in the Master of Nursing Science and DNP/PhD nursing programs in the College of Nursing at Texas Woman’s University. One area of expertise is the use of qualitative research methodologies in understanding phenomena as experienced from the first-person perspective.


The researchers wish to acknowledge the participants for their involvement in the study and Cristina Murray-Krezan, a statistician at the University of New Mexico, for her expertise in data analysis and interpretation. We would like to thank the Scholarship in Education Allocations Committee at the University of New Mexico and the Jean A. Spencer Occupational Therapy Fund at Texas Woman’s University Institute of Health Sciences - Houston Center for providing financial support during the study. We are grateful to the Model of Human Occupation International Institute and American Occupational Therapy Association Education Summit committees who approved the study for dissemination as poster presentations at their conferences in 2017.



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