1. Dr Farzaneh Yazdani Oxford Brookes University 2015
Shift towards spiral curriculum: integration of the Model of Human Occupation across the Occupational Therapy UG course
MOHO therapeutic reasoning volition self causation values interests habit roles habituation performance capacity occupational adaptation assessment change intervention MOHO
Dr Farzaneh Yazdani
Oxford Brookes University 2015

2. Dorset house

3. Oxford Brookes University

4. Occupational therapy team
Farzaneh Yazdani
Margaret Hanson
Leisle Ezekiel
Kellie Tune
Sally Feaver
Emma Lane
Judy Roche
Jenny Butler
Mary Kelly
Sue Hutching
Carol Mytton

5. Identifying the need for change
Preparing staff and students for a more global and international curriculum
Establishing the culture of developing and responding to enquiries among staff and students
Educating students as active, reflective, critical and creative thinkers rather than only skilled technicians
Shifting the role of educators to motivating, encouraging
Shifting responsibility of learning to students
Establishing a fundamental occupation based framework to underpin the overall curriculum
Educating students for ‘how to think’
Linking the contents together
Establishing a central core and philosophy to add to the coherence of modules

6. From where we were to where are going to…
A traditional view of the curriculum was, mostly, of
a series of modules, each with its own teaching plan and assessment.
Aims and objectives
content of the curriculum
teaching methods
assessment
educational strategies
organization of the content and the overall structure of the curriculum.
There was a growing tendency, however, to break down barriers or boundaries between modules and to look at the overall aims or objectives of the curriculum

7. Changes in the curriculum
Beside several changes considered for the new curriculum was having MOHO as one of the two main models underpinning the curriculum.

8. Why spiral curriculum?
We felt we needed to introduce students to the models of practice (here MOHO) in different stages and go into further depth and breadth of the application of the model for different cases, in a variety of contexts and situations
A spiral curriculum is one in which there is an iterative revisiting of topics, subjects or themes throughout the course
A spiral curriculum is not simply the repetition of a topic
It requires also the deepening of it, with each successive encounter building on the previous one

9. Spiral curriculum
We needed to introduce the basic principals of the models, understanding the components and their links to unfolding case scenarios, identifying OT roles and what needed to be learnt from the case in different stages of the intervention
Features of a spiral curriculum:
Topics are revisited
There are increasing levels of difficulty
New learning is related to previous learning
The competence of students increases

10. How did we integrated MOHO into our curriculum?
Bruner has recommended that the early teaching of any subject should emphasize grasping basic ideas intuitively. After that, he believed the curriculum should revisit these basic ideas, building upon them incrementally until students understand them fully
Fundamental concepts of the MOHO
Thinking within a system in the application of MOHO
Steps in therapeutic reasoning
Unfolding the client’s story
Learning from narratives
The logic of the steps of therapeutic rescanning
Applying the steps to diverse groups of clients
Addressing the steps in different modules (systematic thinking and thinking within a system)

11. Learning through enquiry
Layered case scenarios
Thinking about possibilities
'Mastery of the fundamental ideas of a field involves not only the grasping of general principles, but also the development of an attitude toward learning and inquiry, toward guessing and hunches, toward the possibility of solving problems on one's own'. (p.20)

12. Have we followed the Bruner Process of Education?
learning subject structure enables the transfer of training
Structure across the curriculum Readiness through Virtual Learning Environment Seminar plans to address intuitive and analytical thinking Motive for learning??? (Case studies!)
The role of structure in learning and how it may be made central in teaching
readiness for learning
intuitive and analytical thinking
motives for learning

13. Vygotsky: teaching and learning which involve higher mental functions can influence related mental processes in other subject areas.
Therapeutic use of self (IRM) as a way to educate student how to think

14. How do we apply it? Establishing the culture !!
'Learning should not only take us somewhere, it should allow us later to go further more easily'.
Establishing the culture !!

15. Re visiting the Models of Practice

16. The OT UG Curriculum
Year 1: Foundations of knowledge and concepts for understanding occupational performance and occupational therapy.
Year 2: Therapeutic tools for occupational therapy across the lifespan.
Year 3: Occupational therapy for complex cases and contexts of practice

17. Re-visiting the Models of Practice
MOHO across the program

18. First year and MOHO Foundations of Occupational Therapy Practice
Introduction to Theories and models of practice
Introduction thinking within a system
MOHO as model informed by systems theory: fundamental concepts
OT process informed by therapeutic reasoning
In foundations - students are given readings & web-resources which introduce MoHO, CMOPE (& Kawa for MSc students). Students work in groups to prepare a presentation to a small group of other students that introduces the core concepts & core assumptions of the model (MSc students do a comparison of MoHO & Kawa). The lecturer then summarises the model & students are encouraged to consider how they might use the model to analyse person-occupation-environment fit for an adaptive occupation. 
Students then work through psycho-social, cognitive, perceptional, motor, sensory theories of development & each week they consider how they might apply related theories of development alongside MoHO / CMOPE to understand PEO fit / perform an occupational analysis. Students then use MoHO / CMOPE to develop a case formulation - choosing a case study from a range of documentaries. 
In semester 2 students use either MoHO / CMOPE to work through the 6 steps of therapeutic reasoning / OT process - they will explore MoHO assessment tools - considering the body structures, body functions, performance skills & environmental demands of different assessment tools before trying to apply them to a virtual case study. The assessment in semester 2 is an OT assessment report - students are expected to use a model to develop a client profile that justifies their choice of assessment tool & use their model to summarise their assessment results & develop a case formulation. Students also have seminars that explore goal setting & intervention planing using intervention / engagement approaches & they give readings from Kielhofner (2008) that are relevant to these- these are not assessed until year 2. 

19. Second Year and MOHO
Occupational Therapy for Participation across the Lifespan
Applying the first step of therapeutic reasoning to unfold the case scenarios and understand the problems
Identifying needs for further information gathering, second step of therapeutic reasoning
Introduction to assessment tools
Case formulation
Application of model in practice, goal setting and implementation !!!
Determining outcome of therapy

20. Third year and MOHO
Advancing occupational therapy
Reflection and consolidation of the application of the model in practice: how the model informed their goal setting and implementation
Transferring learning to different contexts and variety of diagnosis???

21. What have been the challenges?
'Ideally, interest in the material to be learned is the best stimulus to learning, rather than such external goals as grades or later competitive advantage'. (p. 14)
'Motives for learning must be kept from going passive ... they must be based as much as possible upon the arousal of interest in what there is to be learned, and they must be kept broad and diverse in expression'. (p.80)
Modelling intuitive thinking
Encouraging students to guess
Building students' self-confidence
How many of us believe in this? How many of us could handle this and motivate students to love learning and engage with the course?
Would evidence, narratives of patients and OTs help?
Would applying the OT philosophy into their own life help?
What else?

22. Activities related to MOHO in different stages and across the modules
e.g. : OT international day and application of the MOHO in an international context!!
…a teacher who showed a willingness to guess at answers to questions asked by a class and then subject the guesses to critical analysis may be more likely to build those habits into students than would a teacher who analysed everything for the class in advance.

23. We applied mapping modules across the curriculum
Our strategies to ensure that we are staying within the curriculum as we planned !
Help pupils learn how to learn. Would professional development activities geared towards deepening and extending
formative assessment practices help your colleagues to help their students take more responsibility for their own
learning?
We worked together to plan strategies and spread good practice within and also beyond each module
Planned variety of formative assessments (peer feedback, discussion board, mock exams, etc…
We applied mapping modules across the curriculum

24. Be more open to little deviations from a highly planned curriculum
What else could be done?
Reflection and continuous mapping exercise: “Map” of each level of the spiral, each course in each level and the skills and content to be taught on each occasion.
Be more open to little deviations from a highly planned curriculum
Staff to find and share examples of enquiry based learning and application of the spiral curriculum to underpin their own classroom practices
Do you have colleagues who use cognitive strategies effectively in their teaching who could coach others in their use?

25. Challenges for spiral curriculum and integrating particular models of practice
Staff lack of training/experience in applying the strategies particularly to specific topics such as MOHO
Preference for working alone, each one being busy with their own academic activities or preferences in application of the model s
Huge effort required for meticulously orchestrating the levels of the spiral: engagement- and time-wise.

26. Conclusion
I really enjoyed thinking within the models of practice in particular MOHO. I love MOHO and would like to apply it in my future practice and research…
(3rd year OT student)
To integrate MOHO into the curriculum, staff need to be introduced and motivated to use MOHO as the underpinning model of practice for the teaching material
Spiral curriculum needs collaboration, shared beliefs in philosophy and fundamentals of the curriculum and team work
Enquiry based learning is the most compatible education strategy to the spiral curriculum. However, staff need to have knowledge of the strategies and confident in leading an interactive classroom
Ongoing support for staff from colleagues and the educational system is needed to ensure the success of the program