Pedagogies within occupational therapy curriculum: centering a decolonial praxis in community development practice

Pedagogias dentro do currículo de terapia ocupacional: centrando uma práxis decolonial na prática de desenvolvimento comunitário

Abstract

Introduction

Critical occupational therapy aims to promote occupational justice through addressing the social determinants of health and the socio-political structures that affect peoples’ occupational engagement.

Objective

This paper reports on two objectives from a case study, namely: To describe the teaching and learning practices in South Africa, University of Cape Town Occupational Therapy, Community Development Practice curriculum, and the pedagogy informing it.

Method

Multiple methods were used as data in the construction of the case. These included the review of curriculum documents and a focus group discussion with academics who teach on the programme. These academics also wrote reflective journal entries which were included in our analysis. Data was analysed using a critical interpretive synthesis.

Results

An overarching theme emerged, namely “Modelling a development processes in a teaching and learning alliance”. This theme identified our key pedagogical approach, illustrating how a decolonial praxis that involves consciously resisting coloniality in the design and implementation of the curriculum occurred. This was made possible through pedagogical actions embedded in the approach and reflected in three categories: “Partnering to bring our critically reflexive and authentic selves”; “The labour of working with individual and systemic processes of struggle” and “Being committed to facing uncertainty together”.

Conclusion

Our interpretation of our pedagogical approach within the curriculum demonstrates how decolonial pedagogies open up pathways that promote the kind of dialogic and transformative learning that is important for critical occupational therapy. These decolonial pedagogies hold significance for addressing health inequities and developing a justice-oriented profession.

Keywords:
Social Justice; Education, Higher; Teaching; Learning; Occupational Therapy/ Critical

Resumo

Introdução

A terapia ocupacional crítica visa promover a justiça ocupacional, abordando os determinantes sociais da saúde e as estruturas sociopolíticas que afetam o envolvimento ocupacional das pessoas.

Objetivo

Descrever e examinar a pedagogia aplicada ao currículo de Práticas de Desenvolvimento Comunitário, na Universidade da Cidade do Cabo (UCT), África do Sul.

Método

foram usados múltiplos métodos para a construção do caso. Isso incluiu a revisão de documentos e artefatos associados e uma discussão de grupo focal com acadêmicos que ensinam no programa. Esses acadêmicos também escreveram diários reflexivos que foram incluídas em nossa análise. Os dados foram analisados ​​por meio de uma síntese interpretativa crítica.

Resultados

Um tema abrangente emergiu, a saber: “Modelagem de processos de desenvolvimento em uma aliança de ensino e aprendizagem”. Este tema identificou nossa abordagem pedagógica chave, ilustrando como uma práxis decolonial, abrangendo ações pedagógicas particulares, facilitou mudanças em direção à terapia ocupacional crítica. Essas ações pedagógicas foram refletidas em três categorias: “Parcerias para trazer nosso eu criticamente reflexivo e autêntico”; “O trabalho de desenvolver processos individuais e sistêmicos de luta” e “comprometer-se a enfrentar juntos as incertezas”.

Conclusão

Nossa interpretação sobre a nossa abordagem pedagógica dentro do currículo demonstra como as pedagogias decoloniais abrem caminhos que promovem o tipo de aprendizagem dialógica que é importante para a terapia ocupacional crítica. Essas pedagogias decoloniais são importantes para o desenvolvimento de uma profissão voltada para a justiça.

Palavras-chave:
Justiça Social, Educação Superior; Ensino; Aprendizagem; Terapia Ocupacional/Crítica

Teaching Occupational Justice: Theoretical Grounds to Support Pedagogical Approaches

The Lancet Commission on Education of Health Professionals for the 21st Century detailed the gap, globally, between education systems and health care systems in producing a healthcare workforce (Frenk et al., 2010). To bridge this gap and address health inequities within and between countries, the Commission advocated for reforms in health education that responds to local health inequities while acknowledging the value of global interdependence in knowledge production and utilisation. The Commission’s proposed vision for health education is that “[...] health professionals in all countries are educated to mobilise knowledge, and to engage in critical reasoning and ethical conduct, so that they are competent to participate in patient-centred and population-centred health systems as members of locally responsive and globally connected teams” (Frenk et al., 2010, p. 33). This vision recognises the transformative scale of health profession education to contribute to strengthening health systems locally and globally. This requires that informative (values) and formative (facts and skills) knowledge inherent in curricula be further enhanced with transformative learning (Frenk et al., 2010). Transformative learning develops graduate leadership attributes of information synthesis for decision making; core competencies of effective teamwork and critical use of global resources to address local priorities (Frenk et al., 2010). Changes to university programmes and curricula to develop these leadership competencies will better position health professionals to combat health inequities.

Reducing health inequities is a shared goal of critical occupational therapy and occupational science (Aldrich et al., 2018; Farias et al., 2016; Hammell, 2020). Calls to respond to unfair discrimination contributing to health inequity, such as racism, has been recognised by various professional associations and bodies (American Occupational Therapy Association, 2020; Occupational Therapy Association of South Africa, 2020; Stanley et al., 2020; World Federation of Occupational Therapists, 2020). Critical occupational science and occupational therapy advocates that to engage with issues of inequity we must become politically conscious of how everyday participation differs based on the power associated with collective identities, political and social conditions across different contexts and how this is shaped by the social determinants of health. Drawing on critical theoretical perspectives facilitates a rejection of the individualistic and reductionistic views of human occupation as a sole basis for practice, in favour of a greater appreciation for the influence of contextual and systemic factors on doing in everyday life. This opens up the potential to enact socially transformative practices where occupational justice is promoted (Richards & Galvaan, 2018).

The World Health Organisation’s Rehabilitation Competency Framework (RCF) (World Health Organization, 2020) outlines a set of values, domains and competencies for rehabilitation professions’ education in order to better position the rehabilitation professional workforce to respond to population needs. It identifies the need for rehabilitation professionals’ curricula to develop proficiencies across 5 domains, namely Practice; Professionalism, Learning and development; Management and leadership and Research. The values, knowledge, skills and behaviours inherent in these domains resonates with the transformative learning perspective advocated by the Lancet Commission on the Education of Health Professions. Occupational therapy education should offer the opportunity to learn about how to practice critical occupational therapy advance social transformation and occupational justice (Hansen, 2013; Irvine-Brown et al., 2020; Mahoney & Kiraly-Alvarez, 2019) and respond to population needs effectively. Learning to practice critical occupational therapy means purposefully including such a focus in occupational therapy curricula (Aldrich et al., 2016) as well as developing skills that move beyond the application of techniques in practice (Carrier & Beaudoin, 2020; Robertson et al., 2015). While the educational content and broad educational approach to teaching critical occupational therapy has mostly been identified in the literature (Irvine-Brown et al., 2020; Demers et al., 2021; Hansen, 2013) there has been little detailed description of the pedagogies applied to develop the necessary competencies.

Whilst this is a knowledge gap, previous scholarship has been effective in highlighting the important contribution made through student practice placements within curricula (that is, teaching) for re-orienting practice towards occupational justice (practice), demonstrating the close relationship between pedagogy and practice development. Exploring the practice-theory-teaching interface within occupational therapy curricula that aim to advance a justice-oriented practice could offer insight into the teaching approaches that best facilitate the development of critical occupational therapy practitioners.

The Historical Development of the Community Development Practice (CDP) Occupational Therapy Curriculum at the University of Cape Town (UCT)

Community development practice has been growing alongside various contextually-relevant approaches that are gaining traction globally (Munguba et al., 2018). Occupation-based community development (ObCD) is a form of community development practice in occupational therapy. ObCD synthesises local and global knowledge to respond to health inequities and occupational injustices. Proposed as a framework to guide practice, ObCD provides a way of making sense of and in practice since the “[...] development and implementation of the framework, together with the interpretations of the occupational science constructs embedded within it, are subjected to critical questioning and re-interpretations from marginalized people” (Galvaan, 2021, p. 3-4). The processes of critical questioning and re-interpretations occurs through processes of co-construction. Co-construction refers to the collaborative building of knowledge that intentionally invites multiple perspectives to develop practice that can effectively engage with contextual realities. Since 2000, the first two authors have been engaged in co-constructing the framework with local students, occupational therapists and communities. The evolution of ObCD has contributed to the design and implementation of the community development practice curriculum in the occupational therapy programme at the University of Cape Town (UCT) in South Africa.

The undergraduate degree in Occupational therapy at UCT is a four-year Bachelor of Science (BSc) programme (including Honours), accredited by both the World Federation of Occupational Therapy and the Health Professionals Council of South Africa. Students are required to complete 1000 hours of practice learning¹ and meet the minimum standards across assessments in order to qualify as an independent occupational therapy practitioner. A curriculum review and (re)development process between 2008-2012 led to the structuring and delivery of the programme’s curriculum across five domains of practice, commonly referred to as clusters. These are referred to as Physical Health; Mental Health; Child Learning, Development and Play; Work Practice and Community Development Practice clusters. Two of the authors were part of the team conceptualising Community Development Practice (CDP) as a defined area of knowledge and practice within the broader occupational therapy curriculum. This set the stage for formally bringing the knowledge that had been co-constructed through the process of developing ObCD into the undergraduate curriculum.

The content of each practice cluster is scaffolded across the years in both teaching and practice learning. Knowledge gained in one cluster may be drawn on in another, although the teaching and practice occurs according to distinct contributions. Table 1 details the professional courses included in the OT curriculum across the four years of study. The courses in first and second year include largely foundational content, while in third year content from the physical and mental health practice domains is predominant and, in fourth year work practice, child learning, development and play and community development practice are predominant.

Table 1
Undergraduate occupational Therapy courses in the BSc Occupational Therapy programme at UCT .

Professional Courses in BSc Occupational Therapy Programme
First year	Second year	Third year	Fourth year
AHS1035F: Human Occupation and Development AHS1032S: Occupational Perspectives on Health and Well-being	AHS2043W: Occupational Therapy II	AHS3113W: Foundation Theory for OT Practice I AHS3107W: OT Theory and Practice in Physical Health AHS3108W: OT Theory and Practice in Mental Health	AHS4119W: Occupational Therapy Research and Practice Management AHS4120W: Foundation Theory for OT Practice II AHS4121W: Occupational Therapy practice and service learning

The philosophical orientation to teaching CDP calls on educators to actively create spaces for learning with and from students and marginalised communities, with the intention of surfacing and generating contextually-congruent knowledges that enable a critical occupational therapy practice. This is noteworthy within the South African context where, historically, knowledges and practice in occupational therapy were adopted from Westernised contexts, dominating South African occupational therapy curricula and practices (Joubert, 2010). The evident incongruence between knowledge and the practice context risks practitioners’ capacity to respond to the social conditions affecting peoples’ health (Ned et al., 2017) and prevents the kind of critical engagement required to contribute to justice-oriented solutions.

The close relationship between the development of the CDP curriculum at UCT and the evolution of ObCD, as well as the overt philosophical orientation of the curriculum positions it as a unique case through which we can explore and understand how pedagogies for and practices of critical occupational therapy that reflect transformative learning perspectives might evolve and inform each other.

Research Methods

As educators, practitioners and researchers who had participated in developing the community development practice curriculum at UCT, we set out to conduct a study that would explore the pedagogies within CDP teaching and learning approaches that aim to contribute to developing socially responsive graduates that have the necessary competencies for a justice-focused practice.

Our objectives included:

1. 1

   To describe the teaching and learning practices in the UCT OT CDP curriculum;

2. 2

   To describe the pedagogy informing the UCT OT CDP curriculum in the undergraduate occupational therapy curriculum.

Ethical clearance for the study was obtained from the University of Cape Town Faculty of Health Sciences Research Ethics Committee (HREC no: 023/2019). We designed a qualitative, single instrumental case study (Stake, 1995) to examine the CDP teaching and learning practices as a form of critical occupational therapy. An instrumental case study design was appropriate because it captured the idiosyncrasies of the phenomenon as it emerged within our distinctive context, illuminating key questions (Stake, 1995). Exploring the ‘particular’ through case study research in education offers new ways of understanding that may be relevant across different contexts (Simons, 1996). Our intention was to use the findings from the study to generate local knowledge about developing a justice-orientation to practice that could be of benefit for teaching community development practice in our own context, but also in others.

The boundaries of ‘the case’ for the broader study were defined based on the historical development of ObCD. While many of the theoretical ideas and practices that form part of ObCD have been part of our teaching and learning processes since the year 2000 (when Galvaan initiated a student-led role-emerging practice site in one low-income community in Cape Town (Galvaan, 2004, 2006), it was only in 2013 that an open-education resource on the framework, and the ideas informing it, was published (Galvaan & Peters, 2013). In 2014, the framework became a central part of the CDP curriculum at UCT. This assisted with demarcating the temporal boundary of the case, which was defined as: Teaching and learning of CDP within the UCT undergraduate occupational therapy programme during the period of 2014-2020. This broad boundary helped to define the additional boundaries of the case which included:

1. 1

   Educational practices that have evolved in teaching CDP at UCT since 2014, with a particular focus on current practices used by educators;

2. 2

   Curricula content that was part of teaching and learning CDP as at 2020.

Research Participants

The co-authors of this paper were both the researchers and participants in this study. We employed a purposive approach to selecting participants and invited all educators who, since 2014 have been involved in different ways with the teaching learning and learning of CDP at UCT. The five authors voluntarily consented to participate in the study. All participants were academic staff members within the Division of Occupational Therapy at UCT at the time of the study and their positions are denoted in the Table 2 below:

Table 2
Researcher Participants

Author/Participant	Position at the time of the study
Richards	Senior clinical educator
Francke	Clinical educator
Krenzer	Ad hoc lecturer
Peters	Senior lecturer
Galvaan	Professor

Participants length of experience of teaching and practicing CDP ranged between 7 and 20 years. Since 2014 we have all been involved in different ways with the teaching and learning that is part of the CDP curriculum at UCT. Given that who teaches matters to how teaching and learning occurs (Behari-Leak & McKenna, 2017; Haupt, 2015; Politicsweb, 2015), we identify as able-bodied womxn and our racial profile is that we are three womxn of coloured identity and two white womxn. Our continuous acknowledgment of and taking account of the intersectionality between these identities contributes to our shared commitment to a justice-oriented practice.

Data Sources and Generation

In accordance with the stipulated boundaries of the case, the following sources were selected to generate the data required:

1. 1

   The experiences of educators involved in teaching CDP across the four years of the undergraduate occupational therapy programme at UCT;

2. 2

   Divisional curriculum Health Professionals Council of South Africa (HPCSA) self-review reports that outline the OT curriculum at UCT (reports compiled in 2013 and 2017);

3. 3

   CDP undergraduate course outlines and teaching material, including: Course information booklets; course readers and lecture notes produced for courses; lecture PowerPoint presentations; assignment outlines; practice learning manuals and year timetables;

4. 4

   The posts on a private social media platform (Whatsapp) group chat for educators involved in teaching the CDP curriculum;

5. 5

   Student feedback related to our implementation of the curriculum and shared individually with educators during the selected time period;

6. 6

   Case studies from CDP curriculum website (Facing Up - Pushing Boundaries, 2021a).

Three methods were used for generating the data from these sources:

1. 1

   A document review of sources 2-6 was completed. The documents were available and easily accessible to authors as a consequence of being staff members within the Division of OT;

2. 2

   Educators involved in teaching in the CDP curriculum since 2014 were invited to write individual journal entries to document their critical reflections on the following questions:

   • What does socially transformative practice look like for you?;

   • What has been your experience in teaching/supervising within this curriculum for you as an educator?;

   • What is it about the curriculum that you think contributes towards social transformative practice and why?.

3. 3

   Researchers invited educators to review each other’s journal entries prior to participating in a focus group to further explore ideas shared within these entries. Educators were invited to share their reflections spontaneously and/or deepen their own perspectives in the focus group.

Ensuring trustworthiness

We carefully considered how to manage our dual roles as researchers and participants. To navigate this tension, we drew on the concept of critical subjectivity, which recognises and values the experiential knowledges and identities of the researchers by intentionally bringing these into the research (Maxwell, 2012). This raised our consciousness of and critical reflection on our assumptions, which added to the credibility of the study findings (Maxwell, 2012). In adopting this approach, we were mindful of not only assumptions that needed to be investigated, but also appreciative of different researchers’ critical insights and questions that could contribute to deepening the data analysis. We drew on ideas from the critical dialogical approach (Farias et al., 2018; Galheigo et al., 2017) in order to formulate a structured way to do this. This meant that we reviewed our focus group transcripts and critical reflections to ensure that the data was accurately reflecting our views (Farias et al., 2018) and enabled us to further deconstruct the meanings of different contributions. As such transcripts and reflections were commented on further during the review of the data and the construction of the findings, building on and enriching the initial data sources.

Data analysis and interpretation

Focus group transcripts and journal entries were considered primary data during the data analysis, whereas documents acted as secondary data sources to contextualise the discussion and add further depth to the data introduced through the focus group and journal entries.

We developed a critical thematic synthesis of the data using direct interpretation (Stake, 1995). Since all researchers acted as participants and were grounded in their own experiences and the data, there was some familiarity with the patterns that we identified as we read and re-read the journal entries and focus group transcripts. The process of direct interpretation allowed us to move with these patterns and explore them further in our analysis process, consulting the secondary data sources to confirm or refute these patterns. The result of this process was the inductive identification of categories and a theme that collectively describe the pedagogical practices embedded within the implementation of the CDP curriculum.

As we compiled our description of the categories and theme we chose to dialogue with one another verbally, and in writing, to embrace the critical dialogical approach. To do this we wrote comments in text and posed critical questions regarding interpretations being made about this data. This allowed us to interrogate findings further and cross-check our identification of patterns in the data with one another, as a form of member checking. It also allowed us to identify further data available through the different data sources that could support our interpretations further.

Findings

We begin with a description of the structure and content of the CDP curriculum as it is positioned within the broader undergraduate occupational therapy curriculum at UCT. In line with case study methodology this contributes to providing a rich contextualised account of the phenomenon being explored. We then proceed to present the pedagogies of the CDP curriculum.

Part 1: Contextualising and describing the content and structure of the CDP curriculum

Within the UCT occupational therapy curriculum, CDP is grounded within critical social theoretical perspectives. As is evident from Table 3 (see below), the CDP curriculum draws on diverse disciplinary knowledge, including from the profession of occupational therapy and the disciplines of occupational science, adult education, community development and organisational development. The table offers an overview of the content and structure of the CDP curriculum. It illustrates the scaffolded and iterative understanding that is built across the four years of study through the intentional curation of content. A politically and critically conscious understanding of the transactional relationship between human occupation, health and context is reflected in the content of the curriculum. Our intention is to draw on critical theoretical perspectives that shape our interpretations of human occupation. For instance, we selected four occupational science constructs that form part of what has been framed as the “[...] politics of human occupation construct cluster [...]” (Ramugondo, 2015, p. 497) that we teach as part of CDP content in the final year of study. The nature of the content and the learning spaces created through the pedagogies, described below, enable students to work with emerging and influencing social dynamics and politics in the classroom and during practice learning.

Table 3
Outline of Community Development practice curriculum in the Division of Occupational Therapy, University of Cape Town, South Africa.

Year of Study	Content focus	Brief description of the content	Teaching strategies	Assessment Modalities
First Year	Context of human occupation Occupational Risk Factors The Occupational Therapist as transformative agent	● Knowledge of how environments and contexts may contribute to health/ill-health for groups of people. ● Developing insight into social position(s) and how to position oneself as a socially transformative agent for change.	Lectures and practical sessions	Short answer written test questions
Second Year	Assessment (CRA) using participatory techniques	● Understand how context enables or restricts the participation of vulnerable individuals or groups. ● Develop skill in methods that enable a critical analysis of how the context shapes experiences of marginalisation, and as a consequence development, health and well-being.	Interactive lectures where case studies are used to stimulate discussion.	A CRA group project occurs in which students conduct a CRA in a self-selected community which is accessible to them.
Third Year:	Diversity and Intersectionality Occupational Injustice	● Develop insight into how equity influences interpretations of diversity and how intersectionality relates to power, oppression and privilege in human occupation. ● Develop basic competence in an intersectional analysis to make sense of human occupation in context. ● Theories and concepts of occupational justice	Interactive workshops Lectures	A reflective assignment is completed in diverse pairs where students. An Equity and Diversity reflective log is completed during third year and fourth year practice learning blocks. A written test question.
Fourth Year	Introduction to Human Development Critical OT and Occupational Justice Critical Occupational Science constructs Processes and implementation of the Occupation based community development (ObCD) framework Facilitation of participatory techniques including capacity building, photovoice, action-learning productive conversation and problem-posing	● Development of competence in applying a community development practice process within a community setting. Community settings include organisations that serve marginalised groups towards facilitating the achievement of social justice. During practice learning students are expected to engage with role players, stakeholders and policy across institutional fields and spaces in order to lobby for change within local structures.	Interactive lectures and workshops where knowledge and practice experiences are critiqued. One 6-7 week practice learning block at a community-based site (+/- 220 hours per student) during which students receive individual and group supervision. Tutorials	Students are assessed through a formative CDP assignment where there is an opportunity to consider the theoretical foundations of CDP but also reflect critically on how these foundations might support their practice. Short-answer and essay-type questions nt. As part of each block each student completes two practical demonstrations and their implementation of a CDP OT process is evaluated throughout the block

Part 2: Pedagogies of the curriculum

The approach to teaching used within the CDP curriculum is conceptualized as an overarching theme: “Modelling a development process in a teaching and learning alliance.” Enacting the curriculum in this way requires that, as educators, we participated in teaching as a development process in three important ways: Firstly, by applying a principle of “partnering to bring our critically reflexive and authentic selves” (category 1); secondly by “the labour of working with individual and systemic processes of struggle” (category 2), and thirdly, by “being committed to facing uncertainty together” (category 3). Each of these categories are described below, followed by a description of the theme.

Category 1: “Partnering to bring our critically reflexive & authentic selves”

This category describes the ways in which we, as educators, intentionally partner with students to enact community development practice as a process that unfolds throughout the learning encounter. This process requires both students and educators to (re)imagine the educator-student relationship. In valuing students as equal partners in teaching and learning we recognized the opportunity to learn from and engage with what they bring to the learning process during our focus group discussion:

We have a willingness to be shaped by our students and so forefront that they have knowledges that we can all learn from and that knowledge from outside is not the only source of knowledge needed for change.

As educators we could recognize that relating with students with a respect for the knowledge and experience they bring, meant that we needed to think about the way we serve the process in ways that invites this knowledge into learning encounters. This involved paying significant attention to critical social epistemologies and emergent reasoning in all learning opportunities provided through the teaching content and structure. This approach demands that we critically take account of our positionality in relation to the role of a teacher in order to create space for students’ diverse voices to emerge. This is expressed in the two quotes from our focus group below:

I also think a lot about me being the facilitator of conversations, the difficult conversations, where I have to think about myself as coming from a privileged, white, middle class, heteronormative [position] like, I can almost tick all the boxes, and now being the one standing there and initiating the questions and then [I think] how do I create spaces for voices that don’t usually have space in those settings?”

I purposefully use examples from my own life of relationships I have with others, to make it comfortable for those voices that wouldn’t normally speak and share their experiences and so then after, others [students] would contribute.

This consideration of how we show up as educators and use our authentic selves as tools in facilitating the learning process has resonance with what is expected of students when they use the ObCD process to engage in CDP practice learning placements. We emphasise that students have to discern how to use themselves in ways that extend beyond the implementation of techniques. For instance, a final year lecture on “The development processes in ObCD” captures this idea in a lecture presentation slide, which advocates that:

You are your own most important tool…

We therefore hold the expectation that students develop critical reflexivity in relation to their social identities and positionality in different situations. This is captured on our CDP website (Facing Up - Pushing Boundaries, 2021b) where a story is shared about students working with seniors at a community-based centre. The story highlights how the students were expected to engage in a process of critical self-reflection in order to learn to facilitate processes of change meaningfully:

While engaging with the members [seniors] we also had to be mindful of our positionality and at times intersecting identities as remaining respectful was non-negotiable while working with members. Students had to consider their age, their culture and backgrounds mindfully as they engaged in conversations and realised that moving between their identity as OT students and grandchildren was critical if authentic relationships were to be exactly that. It was healing for both students and residents and made for trusting and authentic relationships (Facing Up - Pushing Boundaries, 2021a).

Through educators encouraging students to engage with their positionality in this way, students found value in creating spaces that nurtured authentic relationships with seniors in the community, which opened up the possibilities for the co-construction of knowledge and action. Communities are explicitly recognised as experts on their lives and contexts, and are thus positioned as able to contribute to leadership in development processes. This is intentionally foregrounded in the curriculum as a key orientation for practice, as is evidenced in the second year lecture content on Context Related Assessment (CRA) (see Table 2). When students learn about CRA we prioritise building a shared understanding of the context and needs as opposed to the traditional modes of clinical practice in which ‘objective’ judgements are made about occupational performance.

During CDP practice learning blocks students are encouraged to recognize how their intersectional identities and experiences adds value to their practice and are expected to be themselves, rather than assume a separate persona of professional identity that distances them from the situations within which they are working. As one of us expressed in our reflective journal prior to the focus group:

I see the disruption happening in terms of how students have been socialized as health professionals and that CDP gives them a different way of enacting their professional identities. My experience of both teaching students in the classroom and supervising them as a clinical educator within this field of practice has shown that students are better able to ‘put themselves back’ into the professional process through this approach.

To model this ‘disruption’, educators are intentional about being themselves, sharing personal experiences with students with the aim of ongoing sense-making of the contradictions inherent in the South African context. This is captured in the quotes below from our focus group discussion:

So when we have supervision on site or, or in any space whether its teaching or PL [practice learning] I find… I share with them in a way that they can see I’m making myself vulnerable so it gives them permission to also go there. So that they can also see I’m freaked out, I’m also scared, you can see my hands are shaking, you can see my voice is changing it should give you a clue that I’m spilling here, I’m actually giving you permission.

The injustices that we see in communities at our sites everyday is sad for all of us. It is sad what you seeing and what you having to cope with as a person. We are constantly being reflexive in relation to what you teaching, it’s about constantly gazing back on oneself. What am I feeling? What am I seeing? We model what authentic engagement looks like in the learning partnership with students. It’s about being real, it’s about being yourself.

We have experienced that this approach works well, particularly in practice learning. One graduate of the BSc (OT) programme expressed the following in feedback about the teaching in CDP:

The framework that CDP offers in the understanding of our intersectional identities allowed us to start being more unashamedly ourselves – I mean owning our identities of being black occupational therapists and seeing parts of our frames of reference as strengths – in the building of relationships with the communities we worked with.

To make the expectation of bringing a critically reflexive self to the process manageable, we deliberately work with students as allies. This involves resisting the hierarchical relationship upheld through the supervisor-student dialectic during practice learning as indicated in the excerpt from a journal entry below:

We intentional about being ourselves and are mindful of how we use our power. It is a sign to the students that this is how we relate and connect who we are to our practice. It gives students permission to learn and share and practice differently.

To resist hierarchy in the educator-student relationship we respect students as being capable of critique of theory and practice:

Students are active thinkers in the designing of practice as opposed to just using principles from somewhere else. We forefront to students that you have the knowledge and students are encouraged to use their knowledges strategically in practice in response to what the context is needing. As educators we support this in practice, teaching and the learning process.

Focus group discussion

We are transparent in acknowledging that, as educators, we don’t hold the knowledge and/or solutions and that thinking and producing knowledge and practice collaboratively is valued. The way we do this is described in the quote below:

When students challenge us, it is welcomed. In our tacit understanding of how we use our power, we are intentional in telling students that we don’t have the answers. We all have to think together and generate what needs to happen next.

Focus group discussion

Prioritising the co-construction of knowledge(s) in the ways described above means that the pressure to adapt predefined solutions or Western practices to better meet the community’s needs no longer preoccupies reasoning. Instead students and communities are at liberty to design contextually-congruent ways to meet the identified needs within the contexts where they live or are learning to practice. We create different ways to recognize students’ contributions, extending an appreciation of value beyond formal assessments. The modelling of this approach in the ways described in this category allows students the opportunity to experience this way of working as part of engaging in the teaching and learning space. Bringing our critical reflexive selves to the learning alliance allows us to engage in the labour of working with individual and systemic processes of struggle together, as part of the focused work of CDP. We describe how we embraced this aspect of the pedagogy in Category 2, which follows.

Category 2: Doing the labour of working with individual and systemic processes of struggle

Category 2 describes how we, as educators, do the labour of working with individual and systemic processes of struggle ourselves, and as part of our students’ lives. The focus on a process-oriented approach, foregrounded by centering the development process in teaching and learning, creates opportunities to consider and work with what emerges for students within their lived realities. This involves appreciating the ways in which students’ experiences are embedded within the social context. The experience of their individual struggles, as these are connected to systemic political, social and economic factors, is brought into the learning space and demonstrates the points of connection that students have with communities. Reflecting on and making sense of the experiences, dilemmas or struggles that students encounter is part of an ongoing learning about CDP that is actively facilitated. This was captured in the following sentiment shared in the focus group:

With every lecture, with every conversation we [educators] have amongst each other, we notice what is happening in the class and begin to consider what needs to be learnt now, who is learning and what it is that needs to be responded to. This then influences how we teach and we keep engaging with the process of facilitation rather than just thinking about the content. In doing this we give students opportunities to contribute to how knowledge is seen as relevant or not. We are intentional in identifying students who come from backgrounds and hold identities that historically isn’t recognised in OT theory and so as we engage, we hold them up as owners of knowledge that has relevance and is valuable in knowing how we respond to the needs presented in our communities.

Monitoring the process of learning as a dynamic social process within the university occurs through listening to and observing the interactions in learning spaces, reflecting on how this relates to societal issues and being alert to opportunities for learning that could come from these. This is demonstrated in the quote below:

We think more about ourselves as facilitators than [as] teachers; where, as a collective in the cluster, we know that there is a set curriculum that students are going through and we actually facilitating and working with what's coming up.

Focus group discussion

The above signals that in CDP we work as a team of educators, giving each other feedback with respect to our developing understanding of the evolving context in relation to our student cohort’s learning, with the view to sharing how learning spaces could be optimally designed and used to respond to what is emerging in real time. This occurred for instance, when South Africa applied strict COVID-19 lockdown regulations in March of 2020 and universities sent students home. After a period of classes being cancelled we were instructed by our university to take learning opportunities online. Our team of educators did not agree that this was the best way to engage students in learning. In order to work with this struggle we designed an opportunity for ourselves, as fellow humans living through the pandemic, to engage in a panel discussion where we reflected both individually and as a collective. We engaged with critical questions regarding our real experiences at the time. We recorded this and posted it for our final year students to view through their online learning platform before they were required to initiate remote learning. A post by one of our educators on our whatsapp group chat identified the initial questions for the panel as:

These are the questions I formulated…

- How has your experiences at this time been points of connection with CDP OT?

- What has been the challenges with thinking and reflecting work at this moment?

- What does self-care look like for you?.

Shortly after having the opportunity to engage in this learning opportunity a student direct messaged one of educators and expressed the following:

I wanted to share a few moments of mine on my real experiences. I can honestly say that OT as a way of thinking (critical OT) really came alive during this pandemic. I am writing this relistening to the first video where you speak about hope… …I can honestly say CDP has allowed and opened up my eyes to analyze and critically observe and reflect on the content of my own life as well as the lives of others.

Monitoring the process of learning as a dynamic social process meant that educators shared their interpretations of the unfolding social dynamics with each other, and with students, so that this could shape teaching. Thus, while the structure and broad content of the curriculum remains the same for every cohort of students, the ways in which the process of learning is facilitated, is different for each. This occurs since the teaching process ss informed by the temporal and contextual reality of the student cohort. This ensures that learning is meaningful and provides students with perspectives of the flexibility required in CDP, as we are able to demonstrate how proficiency in being responsive to emerging needs is pivotal to all practice techniques in both practice learning and in-class teaching spaces. This exposes a demand to, at times, reimagine the application of practice techniques in order to work actively with what is emerging in the ‘now’. An example of this was revealed in one reflection of an experience during practice learning supervision during our focus group discussion:

The techniques being applied were not working in that they were not achieving the outcomes we desired for the dialogue spaces [with a group of seniors in a community-based project]. The student started to critique the technique and I was not resistant to being shaped by students’ knowledge because it was knowledge that was missing. He drew from his intersecting identities with the community members and used this knowledge to re-design and adjust techniques. I wanted him to know that the process needs to be prioritised and we should hold loosely to techniques. We shouldn’t be too committed to prescribed methods, but equally committed to responding to what is happening.

Students recognize their developmental process and appreciated that working with emergent realities is valuable because of their own experience of the benefit of this during their learning. Part of being able to work in this way, however, involves embracing uncertainty during the learning process. Category 3 will describe how we engage with this.

Category 3: Being committed to facing uncertainty together

Category 3 describes how working with uncertainty emerged as significant to individual and systemic processes of struggle for occupational justice. Embracing uncertainty in different ways during CDP is grounded in being authentic to who one is (category 1), while doing the situated and intersectional work associated with social identities and power when engaging in occupations, including learning, in context (category 2). This occurs as part of educators and students continuously making sense of what is happening and needed within a context, as reflected in an excerpt from a case study that is being prepared for our CDP website:

Following a partner-led approach and facilitating a client-driven intervention process was not easy. We knew trust and mutual understanding was missing but to change that we needed to spend time with the carers; and because there was still mistrust and misunderstanding, the carers were resistant to spending time with the students. It was exasperating and at times students and educators were stuck and conflicted. Not knowing how to navigate this.

and so

We were forced to acknowledge that this relational aspect of practice at the site had been neglected over the years. Lockdown was hard but confessing and facing this gap in our practice was really tough. Power dynamics were quite apparent as some [of the carers] had even said that they [UCT OT students] feel they know everything and are better than them. This was humbling and required much reflection and critique around our practice. We were forced to pause. What were we doing to support this statement from carers? It was heavy and conflicting for all of us and we had to rethink everything. Together. How were we contributing to the already existing power dynamics in the Home?

Sense-making in this way was possible because of prioritising a de-centered notion of ourselves as experts in the learning process. This is demonstrated in the excerpt below from a participatory methods lecture:

To be de-centred is a form of liberation for people who’ve found - who’ve thought of themselves as the norm; as the standard, for four - five hundred years. This is part of the freedom [...] (Manoeli, 2018).

Decentering ourselves opens up opportunities to see different possibilities for being and doing. These possibilities are often unknown at the start of interacting with communities. The quote below from our CDP website illustrates this, as we describe a process of students working with a community-based old age home:

Despite these opportunities [to engage in different kinds of occupations], it was concerning to management that the lack of participation could potentially have negative consequences on both physical, mental and social health of the Centre members. It was agreed, that 2 final year OT students will be placed at NOAH over a period of 7 weeks. The role of the students were still undefined and we preferred it this way as it gave us the freedom to be responsive rather than prescriptive in addressing the challenges (Facing Up - Pushing Boundaries, 2021a).

Learning how to relate to people while being uncertain of solutions was viewed as an important skill for working in complex socio-political contexts, such as those students may encounter during community service² after graduation.

Theme: “Modelling a development process in a teaching and learning alliance”

An overarching theme emerged, namely “Modelling a development process in a teaching and learning alliance.” The theme represents the main pedagogical approach used in the CDP curriculum and the categories represent the pedagogical actions that make this approach possible. A visual representation of the theme, and its embedded categories, are captured in Figure 1.

Figure 1
Representation of the theme and categories representing the pedagogical approach and embedded pedagogical actions employed in the teaching and learning process.

Our knowledge of development processes, as enacted through various community development practices, means that we understand that uncertainty is an important aspect to be worked with in such processes. The pedagogy of enacting the CDP curriculum is understood in the same way. At the core of this approach is our commitment to face uncertainty together with our students (category 3). To do this, two important modes of ‘doing’ are required of us as educators: firstly, we must actively partner with students to bring our critically reflexive and authentic selves into our teaching spaces (category 1) and; secondly, we need to do the labour of working with individual and systemic processes of struggle (category 2). These pedagogical ‘actions’ provide continuous opportunities to work with uncertainty (category 3) and model the development process as an ongoing way of demonstrating the kinds of practice that the students, themselves, are expected to enact (the pedagogical approach captured as the overarching theme). We position ourselves as allies alongside students and in this way their learning is supported as they engage with communities in socially responsive ways.

The theme demonstrates that while the content of the curriculum is guided by defined learning outcomes, with research on related constructs, concepts, theories and techniques to inform it, teaching and learning occurs as an occupation of the curriculum. This is captured in the following sentiments expressed and collectively endorsed in our focus group:

The [teaching of the] curriculum is not standardised but rather it’s almost like every year teaching gets shaped. While we do have knowledge content as a basis but there is a lot of process [work] and critique...

During the modelling of the development process we value learning as growth and as a process that unfolds over time. Our lecture content on development draws on definitions of Human Development from the Capability Approach, illustrated in the following final year lecture slide:

[Development is] about expanding the choices people have to lead lives that they value… Fundamental to enlarging these choices is building human capabilities – the range of things that people can do or be in life.

Through engaging the development process as central in the teaching and learning relationship we view our contributions as educators towards developing students’ capabilities to choose how to enact forms of practice that are not only responsive, but that also enable them to work with themselves through this experience. One of us described the ways in which our pedagogical approach to the curriculum made this possible in a journal entry:

This curriculum has made it possible for me to be intentional about blurring the power lines between educator and student. It has allowed me or given me permission to build authentic relationships with students in such a way that I have been better positioned and ‘skilled’ to support and meet their learning needs. I have seen students thrive with the freedom the curriculum has given them to express themselves, their ideas without feeling judged and I have also seen how the curriculum has pushed and shaped others in such a way that helped to question and think critically about their assumptions and lens without feeling judged.

Modelling the development process demands that we bring ourselves to the development process of teaching and learning. Category 1 has highlighted that who we are, and who the students are, as human beings - that is our identities and the different contexts that we participate in - matters in the teaching process. Our intentionality in this regard enables the development process to be centred in promoting learning, as illustrated in the following quote from our focus group:

We have been intentional to engage with where they [the various classes in each cohort of students] are at, who they are as individuals, what their identities are, how they come together as a collective and what the potential is for them [students] to learn from that wisdom from different students’ identities and how its honoured in teaching spaces.

This creates the impetus for all parties involved to be critically reflexive with respect to our social identities and positionality and how it plays out. In this way the relevance of the CDP curriculum content was not only viewed in relation to learning about the practice context, but sought to find resonance with issues to be worked through in the students’ and educators’ lived realities within the South African society (as evidenced in category 2). Bringing our shared lived realities into teaching and working with students’ and educators’ experiences is always encouraged.

Our approach to teaching parallels learning spaces in the CDP curriculum with respect to the participatory enactment of the development process, providing students the opportunity to see this modelled in practice. For instance, students are introduced to participatory ways of conducting a context-related assessment in second year (see Table 2) and also how to embrace a participatory approach in the implementation of methods used in CDP processes in practice during their final year. Just as CDP expects students to enact a participatory approach in practice, allowing spaces for different people to actively contribute to processes that are relevant to their lives, educators enacted a participatory approach to working with students. This enabled an environment where students assumed an active role in their learning. This way of working demanded a respectful cognizance of, and a continual working with, power, intersectionality and privilege as it showed up and shaped the learning space, as captured below:

But over and above foregrounding intellectual wealth and knowledge capital of black students, we get students to think about their positionality and not only within the binaries of black and white. So students who are more privileged, get to reflect on their privilege and how they manage that. I suspect that the kind of content we offer is critical in how students are given spaces to reflect and they use the E&D [equity and diversity] logs to think about how to be different in the world both as people but also as occupational therapists.

Focus group discussion

The pedagogical approach (demonstrated through this theme) and the associated pedagogical actions (described through the categories) have the potential to develop occupational therapists that can engage with issues of social justice as part of their professional role.

Discussion

The pedagogy of the University of Cape Town CDP curriculum described in this paper illustrates a curriculum design that purposefully advances transformative learning. Facilitating transformative learning is demonstrated in modelling the development process in teaching and learning in the CDP curriculum. This was evident in how the teaching and learning was designed and implemented in relation to students’ contexts, including their practice learning experiences. The pedagogical approach and actions are thus influenced by who is teaching, how teaching occurs and who is learning. Such praxis, rooted in reflection and action on people’s subjectivities, histories and struggles has been recognised to promote transformative opportunities where learning may be liberatory (Freire & Freire, 2004). This resonates with the emphasis on nurturing a political consciousness that recognises education as essential for the kind of self-liberation advanced by Biko (Biko & Stubbs, 1978). Developing such consciousness through university curricula creates a foundation for strengthening socially transformative occupational therapy practice (Guajardo et al., 2015) in response to health inequities and social injustices in different contexts.

While the CDP curriculum aimed to be transformative, it did not explicitly set out to be decolonial when it was first designed. However, the approach taken resonates with decolonial perspectives and offers further intellectual and practical grounding for the pedagogical actions and approach of the CDP curriculum. Mignolo & Walsh (2018) proposes decoloniality as a standpoint, as a mode of doing and as a praxis that is pluriversal. Decolonial perspectives in teaching and learning provides options for recognising pluriversal knowledge and dialogic pathways for learning (Walsh, 2018) so as to advance social transformation. Educators and students in this study resisted coloniality by re-inscribing a different way, to the usual hierarchical manner, of knowing and doing within the curriculum. This included resisting the emphasis on the educator’s position of power in the learning relationship, instead embracing the student as a partner. As a consequence, the educator-student relationship was a coalition through which more critical responses to community needs could be generated. This alliance opened pathways to resist expert knowledge as authoritative and allowed students to bring themselves and their contextual knowledge to bear in practicing critical occupational therapy. Contextually-situated knowledges that have emerged from the peripheries, that is, outside of the dominant European and North-American geographical spaces offer knowledges for practice that take into account the political, social and cultural realities of contexts that have had to endure the legacy of colonisation and its ongoing coloniality (Dsouza et al., 2017). Embracing these Southern epistemologies as part of curricula may guide occupational therapists to develop their skills in critically utilising global and local resources to best meet a populations’ needs.

Modelling the development process in teaching and learning evidently offered a way for students to understand how they could also embrace a decolonial praxis with those they served in communities, as described in the findings. Approaching occupational therapy education in this way could contribute to the development of the competencies outlined in the Rehabilitation Competency Framework. It is proposed that these decolonial pedagogies hold significant value for developing critical and emancipatory goals through the profession and resonates with calls for decolonising higher education in Africa (Ndlovu-Gatsheni, 2013), but also globally (Bhambra et al., 2018).

Conclusion and future directions

While the calls to decolonise higher education are not new, Morreira et al. (2020) highlight that the implementation of decoloniality in pedagogical practice remains a challenge. This paper makes a contribution by suggesting how decolonial pedagogies might be enacted within an occupational therapy curriculum that seeks to prepare graduates to engage in a justice-oriented practice, creating transformative learning opportunities to develop a workforce that can adequately meet needs and promote health equity. Whilst the UCT CDP curriculum demonstrated a pedagogical approach and actions that appears to hold significance for learning how to ‘do’ critical occupational therapy, we recognise that the approach presented here might have value for the education of many professionals whose goal it is to serve for public good in the pursuit of equity and justice.

Although the value of the pedagogical approach described has been clearly articulated we recognise the need to triangulate our experiences as educators with the experiences of our students. We also wish to explore how the curriculum has prepared graduates to engage in critical occupational therapy practice after graduation. To this end, further data collection forms part of this study and aimed to explore graduates’ experiences of how the undergraduate UCT community development curriculum generates critical and socially transformative practice. These findings will be reported on in a future publication.

• 1
  Practice learning is the term used to denote the opportunities provided for students within the curriculum to learn to practice whilst contributing to the real-life situations and operations of organisations and services within various sites. In CDP practice learning sites students are often the lead practitioners delivering services.
• 2
  In South Africa occupational therapy graduates are required to complete one compulsory year of service at a designated hospital site prior to being allowed to register with the Health Professions Council as an independent practitioner. They are remunerated accordingly for their service.
• Funding Source University of Cape Town Teaching and Learning Grant (awarded in 2018).

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Edited by

Section editor

Profa. Dr. Michael Palapal Sy

Publication Dates

• Publication in this collection
  08 June 2022
• Date of issue
  2022

History

• Received
  18 Aug 2021
• Accepted
  14 Dec 2021