Early in the profession's history, occupational therapy programs tended to look more alike than different. Students attained many of the skills they needed by taking media courses such as ceramics, wood working, leather crafts, yarn crafts, something called minor crafts, and even type setting. As they learned the use of tools and abilities common to what are usually perceived as creative and artistic efforts, students learned to apply this knowledge to therapy.

In those days, many students were attracted to occupational therapy programs because of their own interest in productive tasks such as arts and crafts. Building upon their earlier knowledge in the manual arts, during their occupational therapy education they learned to analyze and adapt many of these activities to meet the needs of their patients. Therapists drew on their broad knowledge of activity, applying it in every aspect of practice in the treatment of minds and bodies.

Over time there came about an abundant increase in scientific knowledge. It became evident that it was necessary to incorporate much of this scientific material into the curriculum, but the time frame allocated for study did not allow for this added subject matter unless some changes took place. Consequently, faculty began to eliminate certain aspects of media from the curriculum since so many of the students were already skilled in these areas. Soon it became difficult to justify the study of media at all, and many schools eliminated it from the curriculum.

Despite these changes, some schools retained crafts in their curricula, recognizing their therapeutic value and their value as a teaching tool. Since the benefits that derived from an activity-laden curricula was based, for the most part, on anecdotal support, students and younger therapists, who were greatly influenced by society's view of scientific knowledge, began to undervalue crafts, especially when they went on to become faculty themselves.

This ultimately created marked changes in occupational therapy education. Modern curricula look very different from those in the past, and tend to look very different from one another. Today's occupational therapy schools approach education either by eliminating or minimizing the study of crafts, include crafts tangentially as techniques, or integrate craft use as broad-spectrum educational tools. This became evident to me today in our lab.

It is the rare student who enrolls in our program who has previous knowledge or skill in the use of media. As a result, we have a hurdle to pass when we present students with items that they are accustomed to undervaluing. To bypass this bias, we focus on teaching them many things at the same time. We begin by introducing media in a "clay to computers" model mirroring the acquisition of skill that humans transitioned through over the millennia in a process of occupational genesis.

Today, our students were making copper bracelets out of wire. During this activity they were learning to hold needle-nosed pliers to bend the wire into links18 links to be specific. Here's what they learned. They recognized that they could not tolerate repetitive work, particularly of a resistive nature. They learned that they were using intrinsic muscles of their hands, and that the posture of their hands was stimulating the contraction of those muscles. They learned that one could use two pliers at the same time to grasp the wire and bend it effectively, and that jewelers and other workers use these skills. And they learned that these skills would enable them to create dynamic splints.

Each activity that they learn, in turn, brings them to new learning about various aspects of activity, beyond the knowledge of how to do the task. They learn to recognize that activity is only therapeutic when it is meaningful, and that they do not have the right to decide what is meaningful for any other individual. Instead, they have a professional responsibility to meet patients' needs and therefore must be prepared with a wide variety of skills, because they cannot know in advance which activities will have meaning for future patients.

Remarkably, this seems to open them to a willingness to learn broadly, which in turn results in receptivity on the part of patients and supervisors to utilize their skills. What we are finding is that clinical sites are eager to have our students, and invite them to incorporate what they have learned into valuable clinical experiences for patients and colleagues alike.

What goes around comes around ...

Estelle Breines, PhD, OTR, FAOTA, is program director of the occupational therapy program at Seton Hall University School of Graduate Medical Education, South Orange, NJ. Readers may e-mail Dr. Breines at breinees@shu.edu or at otedit@merion.com.